Medicaid Member Experience Representative (Customer Service Representative) I

Network Health Administrative Services, LLC; Menasha (WI); Hybrid; USD 35,000 - 55,000; Full time

Job summary

An established industry player is seeking a dedicated Medicaid Member Experience Representative to enhance the healthcare experience for its members. This role is pivotal in addressing inquiries related to benefits, claims, and authorizations, ensuring that members receive exceptional service with every interaction. With a strong focus on communication and problem-solving, you will guide members through their healthcare needs, providing clarity and support. The position offers a hybrid work environment, allowing flexibility in your work location while maintaining a commitment to service excellence. Join a team that values your contributions and fosters a culture of continuous learning and growth.

Qualifications

• Strong desire to help others and resolve inquiries effectively.
• Previous experience in the insurance industry is a plus.

Responsibilities

• Support members by answering calls and resolving their questions.
• Strive for first call resolution and assist with healthcare inquiries.

Skills

Customer Service

Communication Skills

Problem Solving

Medical Terminology

Insurance Knowledge

Education

High School Diploma or Equivalent

Tools

Computer Systems

Dual Monitors

Job description

Medicaid Member Experience Representative (Customer Service Representative) I

Network Health’s success is rooted in its mission to build healthy and strong Wisconsin communities. This mission guides every decision we make, including the people we choose to join our growing team.

The Member Experience Representative (Customer Service Rep) I will support their assigned line of business by addressing benefit interpretations, claims, authorizations, and other member inquiries in a collaborative and innovative environment. This role involves assisting members with their healthcare questions through phone calls and emails, as well as supporting providers with inquiries about Network Health plans.

Our Member Experience Representatives embody our commitment to “Service Excellence” by guiding members through their healthcare needs. They help members understand their benefits, resolve claim concerns, locate providers, and serve as a resource for healthcare providers. At Network Health, we strive to deliver a better healthcare experience, ensuring members get the help they need with just one call.

Job Responsibilities

• Support our Network Health members by answering calls and proactively work to resolve our members' questions and concerns.
• Strive for first call resolution, working to resolve member issues at the point of contact.
• Use dual monitors while leveraging computer-based resources to find answers to customers' questions and help simplify next steps for members.
• You may reach out to internal departments or external resources to help resolve a member concern.
• We provide a continuous learning environment where you can learn and stay current with our plans, computer systems, and insurance trends.
• You will have the ultimate responsibility of protecting the personal health information of our members.

Requirements

• High school diploma or equivalent
• Strong desire to help others
• Previous experience in the insurance industry is a plus
• Medical terminology background is a plus
• Prior experience with ACA, Medicaid, or similar health plans preferred.
• Excellent communication skills including the ability to clearly explain complicated subjects
• Warm and pleasant demeanor over the phone. We want our members to hear your smile!
• The ability to work in several computer systems and multi-screen set-up and know where to find answers.

We strive to provide amazing service in plain language that our members will understand. The initial training period is a 6-8 week program with a work schedule of Monday - Friday from 8:00am - 4:30pm. After your training, you can select a Monday - Friday work schedule between 8:00am to 6:00pm and Saturday hours from 8:00am - 2:00pm.
Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model.
We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.