Member Experience Specialist I – Health Plans (Hybrid)

Network Health; Menasha (WI); Hybrid; USD 36,000 - 48,000; Full time

Job summary

Network Health in Wisconsin is seeking a Member Experience Representative I to support member inquiries about benefits, claims, authorizations, and provider questions. You will respond by phone and email, document interactions in our systems, and collaborate with internal teams to resolve issues.

The role offers a hybrid work arrangement with a 40-hour work week, primarily 8:00am–5:00pm, and the opportunity to help members navigate their healthcare benefits with clear, friendly communication.

Qualifications

• High school diploma or equivalent.
• Excellent communication skills.
• Experience in the insurance industry is a plus.
• Medical terminology background is a plus.
• Able to explain complex subjects clearly.
• Strong phone presence.

Responsibilities

• Respond to incoming phone calls and emails from members, providers, brokers regarding benefits, coverage, claims, billing, authorizations, and other health plan inquiries.
• Accurately document all customer interactions in the appropriate systems and complete required follow-up activities.
• Collaborate with internal departments to resolve outstanding issues and ensure timely, accurate responses.
• Escalate complex or unresolved issues to a Senior Representative or Supervisor when necessary.
• Meet established departmental quality, productivity, service, and contractual standards.
• Perform other duties and responsibilities as assigned.

Skills

Communication skills

Empathy and customer service

Phone etiquette

Multitasking / computer literacy

Education

High school diploma

Healthcare terminology knowledge

Tools

CRM software

Job description

Network Health in Wisconsin is seeking a Member Experience Representative I to support member inquiries about benefits, claims, authorizations, and provider questions. You will respond by phone and email, document interactions in our systems, and collaborate with internal teams to resolve issues.

The role offers a hybrid work arrangement with a 40-hour work week, primarily 8:00am–5:00pm, and the opportunity to help members navigate their healthcare benefits with clear, friendly communication.