Job Description

At Network Health, our mission to create healthy and strong Wisconsin communities guides everything we do-including how we hire. We are currently seeking a Customer Service Representative (ASO) to support our growing Third Party Administrator (TPA) line of business. Our TPA services operate under an Administrative Services Only (ASO) model, where employers fund their employees' health claims directly, while Network Health provides administrative support to manage those claims and related benefits tasks. This self-funded approach allows employers to retain financial risk while gaining greater cost control and flexibility compared to traditional fully insured plans. In this role, you will provide personalized support to employers and their employees, helping them navigate the complexities of health care and better understand their benefit offerings. Join a company that believes one call should be all it takes. Through our "Service Excellence" model, you'll have the opportunity to make a meaningful impact-resolving issues, educating members, and enhancing the overall health care experience. Location: 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. Travel to the office in Menasha or Brookfield may be required occasionally for the position, including on first day of orientation. Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday Check out our 2024 Annual Report video to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team. Job Responsibilities Deliver outstanding customer service aligned with Network Health's mission, values, and vision. Respond to and resolve inquiries via phone, email, and portal from members, providers, brokers, and employers. Own each inquiry through to resolution, using real-time problem solving or timely follow-up. Accurately document all interactions for legal and statistical purposes. Meet performance standards in speed to answer, call abandonment, customer satisfaction, and first-call resolution. Guide callers to appropriate Exceedent staff for escalated concerns such as precertification, subrogation, claim details, or appeals. Maintain up-to-date knowledge of benefit plan documents (SPD and ASA) and internal policies. Research complex issues using multiple systems and collaborate with internal and vendor teams to resolve inquiries. Educate members on plan benefits and available resources to promote wellness and smart benefit utilization. Make outbound calls as needed to resolve issues and provide additional support. Produce follow-up correspondence in a timely and professional manner. Perform additional duties as assigned. Job Requirements: High school diploma or equivalent (required); additional training in communication and/or medical terminology is preferred. A minimum of three years of customer service experience is required. Experience in a TPA environment, health insurance, or healthcare setting is preferred. Prior call center or phone support experience is a plus. Strong communication skills, problem-solving ability, and attention to detail. Comfort working in fast-paced environments with multiple systems. Network Health is an Equal Opportunity Employer Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. Network Health Plan (Wisconsin)

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