Wisconsin Residents Only – Healthcare Insurance Customer Service

Job Description:

The Member Experience Representative’s primary focus is to answer phone or email inquiries from providers, members, customers, or brokers regarding questions of coverage, claim status, benefit interpretation, billing, and/or authorizations.

Key Responsibilities:
• Answer incoming phone calls efficiently regarding inquiries on coverage, claim status, benefit interpretation, billing, and/or authorizations.
• Respond to inquiries within set timeframes to adhere to department metrics and contractual standards.
• Probe and ask appropriate questions to identify specifics of caller inquiries to ensure first call resolution.
• Document details of interactions within the database, including any additional action steps taken as follow-up.
• Follow-up with customers or other departments on outstanding issues or concerns. Escalate appropriate issues to Supervisor or appropriate individual.
• Support members by answering calls and proactively work to resolve their questions and concerns.
• Strive for first call resolution, working to resolve member issues at the point of contact.
• Use dual monitors while leveraging computer-based resources to find answers to customers’ questions and help simplify next steps for members.
• Reach out to internal departments or external resources to help resolve member concerns.
• Demonstrate commitment and behavior aligned with the philosophy, mission, values, and vision of Network Health.
• Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.

Additional Skills & Qualifications:
• Experience working in a call center preferred.
• Knowledge of basic insurance concepts preferred.
• Intermediate skills in Microsoft Office, including Outlook, Excel, and Word.
• Capacity to multi-task by navigating multiple computer applications and programs simultaneously.

Employee Value Proposition (EVP):

Once hired, there is room for growth outside of the Member Service Rep role.

Work Environment:
• Remote in Wisconsin.
• Hybrid arrangement available with an in-office stipend equivalent to $100 per week, paid in addition to the hourly rate.
• Initial training period is a 6-8 week program with a work schedule of Monday – Friday from 8:00am – 4:30pm. After training, you can select a Monday – Friday work schedule of either 8:30am to 5:00pm or 9:00am – 5:30pm.

Remote Requirements:
• Telecommute work site must be a room with a door that shuts.
• Telecommuting placement will not provide primary care for any individuals during regularly scheduled work hours.
• Reliable internet connection with a minimum of 10 Mbps to accommodate Voice Over Internet Protocol (VOIP).

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)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on May 14, 2025.

About TEKsystems and TEKsystems Global Services

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

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.