Healthcare Navigator

2 weeks ago

Menasha, Wisconsin, United States Network Health Full time
About the Role:
Network Health is seeking a dedicated Customer Service Representative to join our team in Wisconsin. This role plays a vital part in promoting our 'Service Excellence' model by engaging with companies and their employees to navigate healthcare and provide support for better understanding of benefit offerings.

Salary: $45,000 - $60,000 per year, depending on experience.

Responsibilities:
  • 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 appropriately.
  • Respond to and resolve telephone, portal, and email inquiries/issues from members, providers, brokers, and employers.
  • Own each inquiry/issue through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up.
  • Perform data entry at the time of call, documenting all inquiries/issues for legal/statistical purposes.
  • Meet performance goals established for the position in areas such as speed to answer, abandon calls, customer satisfaction, and first call resolution.
  • Channel callers and facilitate referrals to appropriate Exceedent staff for escalated issues, precertification, subrogation, claim detail, or appeals.
  • Produce follow-up correspondence to callers in a timely manner.
  • Maintain knowledge of SPDs and ASA documents for assigned employer groups and 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.
  • Perform outbound calling as directed or needed to resolve issues and answer questions.
  • Guide and educate customers about benefits offered under the plan and by vendors to facilitate maximizing the value of their health plan benefits and promote wellness.

Requirements:
  • High school diploma or equivalent preferred.
  • Additional training in communication skills required.
  • Medical Terminology training preferred.
  • A minimum of three years of customer service experience required.
  • TPA environment, health insurance, or healthcare clinic experience preferred.
  • Telephone experience in a call center setting or phone support role also preferred.

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