Member Experience Representative- REMOTE Must Be In WI
Milwaukee Succeeds, Goerkes Corner, WI, United States
Member Experience Representative – Remote (WI)
This is a Contract to Hire position based out of Brookfield, WI. The position is fully remote.
Job Responsibilities
Answer phone and email inquiries from providers, members, customers, or brokers regarding coverage, claim status, benefit interpretation, billing, and authorizations.
Utilize expertise in Medicare or Group/Marketplace business lines to translate health‑care jargon into clear communication.
Document interaction details in the database, including any action steps taken as follow‑up.
Demonstrate commitment and behavior aligned with Network Health's philosophy, mission, values, and vision.
Apply organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.
Handle incoming calls efficiently, meeting department metrics and contractual standards.
Probe callers to ensure first‑call resolution.
Follow up on outstanding issues or concerns, escalating appropriate matters to a supervisor.
Support members by proactively resolving their questions and concerns.
Use dual monitors and computer‑based resources to answer questions and simplify next steps for members.
Coordinate with internal departments or external resources to resolve member concerns.
Protect the personal health information of members.
Key Skills
Insurance, EOB, Healthcare Customer Service, Metrics, Medicaid, Medicare, Call Center, Insurance Verification, Prior Authorization, Dental Insurance
Additional Skills & Qualifications
Experience working in a customer‑service‑focused industry (strongly desired).
Experience working in a call center (preferred).
Knowledge of basic insurance concepts (preferred).
Strong oral and written communication skills with the ability to listen mindfully, identify gaps, and ask appropriate questions.
Ability to organize work and workspace to ensure timely completion of assigned tasks.
Ability to adapt to new circumstances, information, and challenges in a fast‑paced environment.
Ability to work independently and as part of a team.
Strong conflict‑management skills, ability to deescalate situations and resolve customer or member concerns while maintaining service excellence standards.
Capability to work in a fast‑paced environment with a constant volume of phone inquiries or email messages.
Capacity to multi‑task using multiple computer applications and programs simultaneously.
Intermediate skills in Microsoft Office, including Outlook, Excel, and Word.
Ability to comprehend and educate members on multiple lines of business.
Experience Level
Expert Level
Pay and Benefits
Pay: $18.25 per hour
Eligibility requirements apply to some benefits and may depend on job classification and length of employment. Benefits are subject to change.
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
This position is anticipated to close on Apr 29, 2026.
Workplace Type
This is a fully remote position.
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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This is a Contract to Hire position based out of Brookfield, WI. The position is fully remote.
Job Responsibilities
Answer phone and email inquiries from providers, members, customers, or brokers regarding coverage, claim status, benefit interpretation, billing, and authorizations.
Utilize expertise in Medicare or Group/Marketplace business lines to translate health‑care jargon into clear communication.
Document interaction details in the database, including any action steps taken as follow‑up.
Demonstrate commitment and behavior aligned with Network Health's philosophy, mission, values, and vision.
Apply organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.
Handle incoming calls efficiently, meeting department metrics and contractual standards.
Probe callers to ensure first‑call resolution.
Follow up on outstanding issues or concerns, escalating appropriate matters to a supervisor.
Support members by proactively resolving their questions and concerns.
Use dual monitors and computer‑based resources to answer questions and simplify next steps for members.
Coordinate with internal departments or external resources to resolve member concerns.
Protect the personal health information of members.
Key Skills
Insurance, EOB, Healthcare Customer Service, Metrics, Medicaid, Medicare, Call Center, Insurance Verification, Prior Authorization, Dental Insurance
Additional Skills & Qualifications
Experience working in a customer‑service‑focused industry (strongly desired).
Experience working in a call center (preferred).
Knowledge of basic insurance concepts (preferred).
Strong oral and written communication skills with the ability to listen mindfully, identify gaps, and ask appropriate questions.
Ability to organize work and workspace to ensure timely completion of assigned tasks.
Ability to adapt to new circumstances, information, and challenges in a fast‑paced environment.
Ability to work independently and as part of a team.
Strong conflict‑management skills, ability to deescalate situations and resolve customer or member concerns while maintaining service excellence standards.
Capability to work in a fast‑paced environment with a constant volume of phone inquiries or email messages.
Capacity to multi‑task using multiple computer applications and programs simultaneously.
Intermediate skills in Microsoft Office, including Outlook, Excel, and Word.
Ability to comprehend and educate members on multiple lines of business.
Experience Level
Expert Level
Pay and Benefits
Pay: $18.25 per hour
Eligibility requirements apply to some benefits and may depend on job classification and length of employment. Benefits are subject to change.
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
This position is anticipated to close on Apr 29, 2026.
Workplace Type
This is a fully remote position.
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