Insurance Verification Specialist

TEKsystems; Milwaukee (WI); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Member Experience Representative to enhance customer satisfaction through effective communication and problem resolution. This role involves answering inquiries about coverage, claims, and benefits while ensuring compliance with organizational policies. As a fully remote position, you will have the flexibility to work from home while being part of a dedicated team committed to delivering exceptional service. If you have a background in call centers or insurance and are passionate about helping others, this opportunity is perfect for you.

Benefits

Medical, dental & vision

401(k) with pre-tax and Roth options

Life Insurance

Disability Insurance

Employee Assistance Program

Paid Time Off (PTO, Vacation, Sick Leave)

Qualifications

• Proficient in Medicare or Group/Marketplace.
• Ability to translate healthcare jargon for better understanding.

Responsibilities

• Answer incoming phone calls regarding coverage and claims.
• Follow-up with customers or departments on outstanding issues.

Skills

Call center experience

Insurance, Medicare experience

Group insurance, benefit interpretation, claims

Job description

Description:

The Member Experience Representative's primary focus is to answer phone or email inquiries from providers, members, customers, or brokers regarding questions of coverage, claim status, benefit interpretation, billing, and/or authorizations.

Proficient in one line of business, either Medicare or Group/Marketplace, translating healthcare-related jargon into effective written or verbal communication for the end user to comprehend.

Document details of the interaction within the database, including any additional action steps taken as follow-up.

Demonstrate commitment and behavior aligned with the philosophy, mission, values, and vision of Network Health.

Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.

Responsibilities:

1. Answer incoming phone calls efficiently regarding inquiries on coverage, claim status, benefit interpretation, billing, and/or authorizations.
2. Respond to inquiries within set timeframes to adhere to department metrics and contractual standards.
3. During calls, probe and ask appropriate questions to identify specifics of the inquiry to ensure first call resolution.
4. Follow-up with customers or other departments on outstanding issues or concerns, escalating issues when necessary.

Top Skills:

• Call center experience
• Insurance, Medicare experience
• Group insurance, benefit interpretation, claims

Details:

Pay: $17 to $18.25/hr

Training: Monday to Friday, 8am to 4pm, 6 to 8 weeks

Shift: Monday to Friday, 8:30am to 5pm or 9am to 5:30pm

Location:

Remote in Wisconsin

Benefits:

• Medical, dental & vision
• Critical Illness, Accident, Hospital
• 401(k) with pre-tax and Roth options
• Life Insurance, Disability, HSA
• Transportation benefits, Employee Assistance Program
• Time Off (PTO, Vacation, Sick Leave)

Workplace Type:

Fully remote

Application Deadline:

May 14, 2025

About TEKsystems:

Leading provider of business and technology services, working with over 6,000 customers including 80% of the Fortune 500. Focused on strategy, design, execution, and operations to unlock business value.

Equal opportunity employer, considering all applications regardless of protected characteristics.