Member Services Rep

Clear Destination Inc.; Madison (WI); Hybrid; USD 42,000 - 54,000; Full time

Job summary

GHC-SCW is hiring a Full-time Member Services Representative to respond to member and provider inquiries about benefits, claims, referrals and clinic services. The role includes resolving complaints, interviewing complainants, and reporting details to staff, with data entry and file maintenance responsibilities.

The position operates under the Member Services Manager, with a strong emphasis on confidentiality, excellent service, and professional conduct in a healthcare setting.

Qualifications

• High school education or equivalent required.
• Minimum of two years' experience in a public contact position.
• Knowledge of or ability to learn GHC-SCW benefit plans and clinic operations.
• Knowledge of and basic ability to use Microsoft Office and email.
• Ability to use and/or learn on-line information systems such as EPIC.
• Excellent verbal and written communication skills.

Responsibilities

• Respond to members and providers benefits, claims, referral and clinic services inquiries.
• Assist members with the resolution of complaints including interviewing, investigation and reporting.
• Maintain departmental data entry and records as needed.
• Work under supervision of the Member Services Manager.

Skills

Customer service

Verbal communication

Multitasking

Typing 35 wpm

HIPAA knowledge

Microsoft Office

EPIC

Education

High school diploma or equivalent

Tools

EPIC

Microsoft Office

Job description

Full time position with the opportunity to work remote/virtual or hybrid after successful completion of a 6-month probationary period.

*Applicants must reside locally and in Wisconsin to be available for on-site meetings and trainings.

The Member Services Representative serves as the primary resource person responding to members and providers benefits, claims, referral and clinic services inquiries. This position assists members with the resolution of complaints including interviewing of complainants, investigation of the complaint and reporting the details of complaints to internal staff as appropriate. In addition, the Member Services Representative is responsible for departmental data entry and maintenance of files/records as needed. The incumbent functions under the general guidance, direction and supervision of the Member Services Manager.

The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner.The incumbent understands our Mission, Vision and Common Values (stated below) and is committed to promote these values in behavior and attitude.

JOB SPECIFIC QUALIFICATIONS

1. High school education or equivalent required.
2. Minimum of two (2) years' experience in a responsible public contact position required. Experience with an insurance, HMO, or healthcare related operation is desirable but not required.
3. Knowledge of or ability to learn GHC-SCW benefit plans and clinic operations required.
4. Knowledge of and basic ability to use various computer software including Microsoft Office and email.
5. Ability to use and/or learn on-line information systems such as EPIC.
6. Excellent verbal communication and listening skills both in-person and on the phone required. Strong written communication skills.
7. Excellent customer service skills required. Ability to be culturally sensitive and to work with a diverse patient population. Ability to maintain telephone etiquette.
8. Ability to act in a professional manner when dealing with practitioner staff, personnel of other departments, fellow employees and the general public required.
9. Ability to maintain patient and organizational confidentiality required. Knowledge of or ability to learn HIPAA requirements.
10. Ability to diplomatically handle communications in potentially stressful situations.
11. Excellent problem solving (investigating/explaining) skills required.
12. Excellent record keeping/organizational skills required.
13. Excellent interpersonal skills required.
14. Ability to work independently and manage time well required.
15. Ability to handle multiple projects simultaneously required.
16. Ability to type 35 wpm accurately required.
17. Ability to lift from arm to floor level and occasionally carry bulky loads ranging from 2-15 lbs required.
18. Ability to speak and hear on the telephone and in person required.
19. Near vision and mid-range vision required.
20. Physical agility in standing, stooping, kneeling, crouching, reaching (above shoulder, over 18" and to floor), handling and fingering required.

Our Mission Statement:

We partner with members and the communities we serve to maximize health and well-being.

Our Vision:

As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.

Our Values:

• We are a not-for-profit Cooperative
• We are member-centered
• We are equitable and inclusive
• We are quality-driven
• We are innovative
• We are community involved

GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.

We believe:

Healthcare is a human right.

In treating all people with dignity and respect.

There is strength in diversity.

Equity celebrates our humanity.