Member Experience Representative I

Network Health's success is deeply rooted in its mission to build healthy and strong Wisconsin communities. This mission shapes every decision we make, including the selection of individuals who join our growing team.

The Member Experience Representative I will support our various 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.

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 of either 8:00am to 4:30pm or 8:30am to 5:00pm.

Location: 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 with our hybrid workplace model.

Brookfield In-Office Support: Employees who are able to work a hybrid schedule in our Brookfield office (16960 W. Greenfield Ave., Suite #5) qualify for an additional $5.00 per hour in recognition of in-office support.

Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday.

Target Start Date: This position has a target start date of May 18, 2026, or June 1, 2026, contingent upon the candidate's availability to begin employment.

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities

• Demonstrate commitment to and behavior aligned with the philosophy, mission, values, and vision of Network Health.
• Apply organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies appropriately.
• Efficiently handle incoming phone calls from members, customers, providers, or brokers regarding inquiries related to coverage, claim status, benefit interpretation, billing, and authorizations. Respond to inquiries within established timeframes to meet department metrics and contractual standards.
• Proactively ask probing questions during calls to clarify caller concerns and ensure first-call resolution.
• Follow up with customers or other departments on outstanding issues to ensure timely resolution. Escalate unresolved issues to the Supervisor or appropriate individual as needed.
• Perform other duties as assigned.
  
  

Job 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
• 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