Member Experience Representative I

Job Responsibilities

• Demonstrate behaviors that align with Network Health's mission, vision, values, and organizational philosophy.
• Consistently comply with all organizational policies, regulatory requirements, credentialing standards, and applicable procedures.
• Respond professionally and efficiently to incoming phone calls from members, customers, providers, and brokers regarding benefits, coverage, claims, billing, authorizations, and other health plan inquiries.
• Utilize active listening and effective questioning techniques to fully understand the caller's needs and achieve first-call resolution whenever possible.
• Accurately document all customer interactions within the appropriate systems and complete required follow-up activities in a timely manner.
• Collaborate with internal departments to resolve outstanding issues and ensure timely, accurate responses to customer inquiries.
• Escalate complex or unresolved issues to a Senior Representative, Supervisor, or other appropriate resource when necessary.
• Maintain and exceed established departmental quality, productivity, service, and contractual performance standards.
• Perform other duties and responsibilities as assigned.

Job Requirements

• High school diploma or equivalent.
• Strong desire to help others.
• Previous experience in the insurance industry is a plus.
• Medical terminology background is a plus.
• Excellent communication skills including the ability to clearly explain complicated subjects.
• A warm and pleasant demeanor over the phone. We want our members to hear your smile!
• The ability to work in several computer systems and multi-screen set-up and know where to find answers.

Network Health is an Equal Opportunity Employer.