Customer Service Representative

1 month ago

Brookfield, United States Network Health Full time
Description

Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team.

Network Health is seeking a Customer Service Representative (ASO) who will be responsible for promoting our "Service Excellence" model by helping engage companies and their employees to navigate health care and to provide support to better understand their benefit offerings. At Network Health we strive to bring a better healthcare experience and ensure that members only need to call once to get the help they need. Our programs enhance convenience, improve employee health and help lower costs so our members make the most of their health care benefits.

Job Responsibilities

  • 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
  • Responds to and resolves telephone, portal and email inquiries/issues from members, providers, brokers, and employers.
  • Owns each inquiry/issue through to resolution on behalf of the customer in real time or through comprehensive and timely follow up.
  • Performs data entry at the time of call, documenting all inquiries/issues for legal/statistical purposes.
  • Meets the performance goals established for the position in the areas of; Speed to answer, abandon calls, customer satisfaction and first call resolution.
  • Channels callers and facilitates referrals to appropriate Exceedent staff for escalated issues, precertification, subrogation, claim detail, or appeals.
  • Produces follow-up correspondence to callers in a timely manner.
  • Maintains knowledge of the SPDs and ASA documents for all assigned employer groups. Maintains knowledge of the Operations department policies and procedures.
  • Research complex issues across multiple databases on behalf of the customer and work/partner with Exceedent staff and vendor staff to resolve customer issues.
  • Performs outbound calling as directed or needed to resolve issues and answer questions.
  • Guides and educates customers about the benefits offered under the plan and by our vendors to facilitate maximizing the value of their health plan benefits to promote wellness.
  • Other duties as assigned.

Minimum Education Required
High school diploma or equivalent is preferred. Additional training in communication skills is required. Medical Terminology training is preferred.

Minimum Related Years of Experience (per minimum education) Required
A minimum of three years of customer service experience is required. TPA environment, health insurance or healthcare clinic experience is preferred. Telephone experience in a call center setting or phone support role is also preferred.

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 in our hybrid workplace model.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.

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