Member Experience Representative

TEKsystems
$18.25 / hr
life insurance, sick time, 401(k), retirement plan
United States, Wisconsin, Brookfield
Apr 08, 2025
Job Title: Member Experience Representative Description: Are you passionate about helping others and providing exceptional customer service? Join our team as a Member Experience Representative and make a difference in the lives of our members! We are looking for dedicated individuals who can effectively communicate and resolve inquiries related to coverage, claim status, benefit interpretation, billing, and authorizations. Key Responsibilities: * Answer Inquiries: Respond to phone and email inquiries from providers, members, customers, or brokers regarding coverage, claim status, benefit interpretation, billing, and authorizations. * Specialize in One Line of Business: Be proficient in either Medicare or Group/Marketplace, translating healthcare jargon into clear, understandable communication. * Document Interactions: Accurately document details of interactions and follow-up actions in our database. * Align with Our Values: Demonstrate commitment to our philosophy, mission, values, and vision. * Apply Regulations: Appropriately apply organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies. * Efficient Call Handling: Answer incoming calls efficiently and respond to inquiries within set timeframes to meet department metrics and contractual standards. * First Call Resolution: Probe and ask appropriate questions to identify caller needs and ensure first call resolution. * Follow-Up: Follow up with customers or other departments on outstanding issues and escalate appropriate issues to supervisors or relevant individuals. Additional Details: * Support Members: Proactively work to resolve member questions and concerns, striving for first call resolution. * Utilize Technology: Use dual monitors and computer-based resources to find answers and simplify next steps for members. * Collaborate: Reach out to internal departments or external resources to help resolve member concerns. * Continuous Learning: Stay current with our plans, computer systems, and insurance trends in a continuous learning environment. * Protect Information: Ensure the protection of personal health information of our members. Qualifications: * Experience in a customer service-focused industry is strongly desired. * Call center experience is preferred. * Knowledge of basic insurance concepts is preferred. * Strong oral and written communication skills with the ability to listen mindfully and ask appropriate questions. * Ability to organize work and space to complete tasks within identified timeframes. * Adaptability to new circumstances and challenges in a fast-paced environment. * Ability to work independently and as part of a team. * Strong conflict management skills to resolve and deescalate situations while maintaining service excellence standards. Functional Skills: * Ability to handle a high volume of phone inquiries or email messages in a fast-paced environment. * Capacity to multi-task by navigating 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 for their inquiries. Why Join Us? * Be part of a team that values your contributions and supports your growth. * Work in a dynamic and fast-paced environment where no two days are the same. * Enjoy opportunities for career advancement and professional development. * Make a real impact by delivering exceptional service and solutions. 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 Apr 21, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.