Healthcare Member Representative
Milwaukee Succeeds, Goerkes Corner, WI, United States
Member Experience Representative | Location: Remote within Wisconsin | (Hybrid after 90 days – Menasha or Brookfield, WI) | Schedule: Monday-Friday, 8:00 AM-4:30 PM | Pay Rate: $18.25/hour | Employment Type: Contract-to-Hire (90 days)
About the Role
We’re seeking a Member Experience Representative who is passionate about helping people navigate the healthcare system. In this role, you’ll be on the front lines—supporting members, providers, and partners by answering questions, resolving issues, and ensuring a positive, high‑quality experience with every interaction.
This role is ideal for someone with a strong healthcare customer service background, especially with Medicaid or Medicare, who thrives in a fast‑paced, call‑center environment and values first‑call resolution.
What You’ll Do
Handle inbound phone calls and emails from members, providers, and brokers regarding coverage questions, claims status, benefits explanation, and billing and authorizations.
Specialize in one line of business (Medicare or Group/Marketplace) and clearly explain complex healthcare information in a way members can understand.
Strive for first‑call resolution by asking thoughtful, probing questions.
Accurately document all interactions, outcomes, and follow‑up steps in internal systems.
Collaborate with internal departments and external partners to resolve outstanding issues.
Escalate complex concerns to leadership when appropriate.
Protect member Personal Health Information (PHI) at all times.
Stay current on plans, systems, and insurance trends through ongoing training.
What We’re Looking For – Required Experience & Skills
2+ years of Medicaid experience (strongly preferred).
2+ years of healthcare customer service or call‑center experience.
Healthcare or insurance background required.
Experience with insurance verification, Medicare, Explanation of Benefits (EOBs), and prior authorizations.
Nice to Have
Dental insurance background.
Key Qualifications
Strong verbal and written communication skills.
Ability to de‑escalate situations and resolve conflicts professionally.
Comfort navigating multiple systems with dual monitors.
Intermediate Microsoft Office skills (Outlook, Excel, Word).
Highly organized, adaptable, and able to work independently or as part of a team.
Experience working in metrics‑driven environments a plus.
Work Environment & Schedule
Remote for first 90 days.
After conversion: Hybrid schedule – 3 days onsite / 2 days remote.
Onsite rotation approximately once every 4–6 weeks.
Must be able to pick up equipment onsite (Menasha or Brookfield).
Onsite Pay Incentives
Additional $2.50/hour for weeks worked onsite.
After 6 months, option for $5/hour onsite stipend for those willing to work onsite more regularly.
Dress Code
Business casual (business professional on your first day).
Growth & Compensation Perks
Wage increases tied to performance metrics.
Strong internal mobility and career growth opportunities after hire.
Supportive, member‑focused culture with a commitment to learning and development.
Pay and Benefits
The pay range for this position is $18.25 – $18.25/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
Medical, dental & vision.
Critical Illness, Accident, and Hospital.
401(k) Retirement Plan – Pre‑tax and Roth post‑tax contributions available.
Life Insurance (Voluntary Life & AD&D for the employee and dependents).
Short and long‑term disability.
Health Spending Account (HSA).
Transportation benefits.
Employee Assistance Program.
Time Off/Leave (PTO, Vacation or Sick Leave).
Application Deadline
Position is anticipated to close on Apr 30, 2026.
Equal Opportunity Statement
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information, or any characteristic protected by law.
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About the Role
We’re seeking a Member Experience Representative who is passionate about helping people navigate the healthcare system. In this role, you’ll be on the front lines—supporting members, providers, and partners by answering questions, resolving issues, and ensuring a positive, high‑quality experience with every interaction.
This role is ideal for someone with a strong healthcare customer service background, especially with Medicaid or Medicare, who thrives in a fast‑paced, call‑center environment and values first‑call resolution.
What You’ll Do
Handle inbound phone calls and emails from members, providers, and brokers regarding coverage questions, claims status, benefits explanation, and billing and authorizations.
Specialize in one line of business (Medicare or Group/Marketplace) and clearly explain complex healthcare information in a way members can understand.
Strive for first‑call resolution by asking thoughtful, probing questions.
Accurately document all interactions, outcomes, and follow‑up steps in internal systems.
Collaborate with internal departments and external partners to resolve outstanding issues.
Escalate complex concerns to leadership when appropriate.
Protect member Personal Health Information (PHI) at all times.
Stay current on plans, systems, and insurance trends through ongoing training.
What We’re Looking For – Required Experience & Skills
2+ years of Medicaid experience (strongly preferred).
2+ years of healthcare customer service or call‑center experience.
Healthcare or insurance background required.
Experience with insurance verification, Medicare, Explanation of Benefits (EOBs), and prior authorizations.
Nice to Have
Dental insurance background.
Key Qualifications
Strong verbal and written communication skills.
Ability to de‑escalate situations and resolve conflicts professionally.
Comfort navigating multiple systems with dual monitors.
Intermediate Microsoft Office skills (Outlook, Excel, Word).
Highly organized, adaptable, and able to work independently or as part of a team.
Experience working in metrics‑driven environments a plus.
Work Environment & Schedule
Remote for first 90 days.
After conversion: Hybrid schedule – 3 days onsite / 2 days remote.
Onsite rotation approximately once every 4–6 weeks.
Must be able to pick up equipment onsite (Menasha or Brookfield).
Onsite Pay Incentives
Additional $2.50/hour for weeks worked onsite.
After 6 months, option for $5/hour onsite stipend for those willing to work onsite more regularly.
Dress Code
Business casual (business professional on your first day).
Growth & Compensation Perks
Wage increases tied to performance metrics.
Strong internal mobility and career growth opportunities after hire.
Supportive, member‑focused culture with a commitment to learning and development.
Pay and Benefits
The pay range for this position is $18.25 – $18.25/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
Medical, dental & vision.
Critical Illness, Accident, and Hospital.
401(k) Retirement Plan – Pre‑tax and Roth post‑tax contributions available.
Life Insurance (Voluntary Life & AD&D for the employee and dependents).
Short and long‑term disability.
Health Spending Account (HSA).
Transportation benefits.
Employee Assistance Program.
Time Off/Leave (PTO, Vacation or Sick Leave).
Application Deadline
Position is anticipated to close on Apr 30, 2026.
Equal Opportunity Statement
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information, or any characteristic protected by law.
#J-18808-Ljbffr