JOB REQUIREMENTS: Network Health\'s success is rooted in its mission tocreate healthy and strong Wisconsin communities. It drives the decisionswe make, including the people we choose to join our growing team. OurMember Experience Representative I will support our Group/Commercialline of business with benefit interpretation, claims, authorizations andother member inquiries in a collaborative, innovative environment. Theperson in this role will support our members through their healthcarequestions via customer calls and e-mails or help providers withanswering questions about our Network Health plans. Our MemberExperience Representative promotes our \"Service Excellence\" value byhelping members navigate their healthcare needs by explaining theirbenefits, solving claim concerns, finding a doctor in their area, orbeing their healthcare provider support. At Network Health we strive tobring a better healthcare experience and ensure that members only needto call once to get the help they need. Job Responsibilities - Supportour Network Health members by answering calls and proactively work toresolve our members questions and concerns. - Strive for first callresolution, working to resolve member issues at the point of contact. -Use dual monitors while leveraging computer-based resources to findanswers to customers questions and help simplify next steps formembers. - You may reach out to internal departments or externalresources to help resolve a member concern. - We provide a continuouslearning environment where you can learn and stay current with ourplans, computer systems, and insurance trends. - You will have theultimate responsibility of protecting the personal health information ofour members. Check to ensure that appropriate changes were made toresolve customers\' problems. Complete contract forms, prepare change ofaddress records, or issue service discontinuance orders, usingcomputers. Confer with customers by telephone or in person to provideinformation about products or services, take or enter orders, cancelaccounts, or obtain details of complaints. Contact customers to respondto inquiries or to notify them of claim investigation results or anyplanned adjustments. Review insurance policy terms to determine whethera particular loss is covered by insurance. Review claims adjustmentswith dealers, examining parts claimed to be defective, and approving ordisapproving dealers\' claims. Resolve customers\' service or billingcomplaints by performing activities such as exchanging merchandise,refunding money, or adjusting bills. Refer unresolved customergrievances to designated departments for further investigation.***** OTHER EXPERIENCE AND QUALIFICATIONS: - Strong desire to helpothers - Previous experience in the insurance industry is a plus -Medical terminology background is a plus - Excellent communicationskills including the ability to clearly explain complicated subjects -Warm and pleasant demeanor over the phone. We want our members to hearyour smile! - The ability to work in several computer systems andmulti-screen set-up and know where to find answers *****APPLICATION INSTRUCTIONS: Apply Online:https://recruiting.ultipro.com/NET1004/JobBoard/4854471e-f2ab-4bed-a3cd-3f7a1072bfef/OpportunityDetail?opportunityId=f767d449-cedf-49e5-8fbb-148f05c41858