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Network Health

59 jobs near Columbus, OH

Network Health

Database Administrator

Menasha, WI · On-site +1

The Database Administrator will design, install, monitor, maintain, and optimize Network Health Plan databases while ensuring high levels of data availability. This position is responsible for ...

Network Health

Associate Medical Director

Menasha, WI · On-site +1

... to Network Health (NH) members. This individual will be chair of at least 3 committees related to quality and accreditation. Location: Candidates must reside in the state of Wisconsin for ...

Network Health

Quality Care Coordinator

Menasha, WI · Hybrid

The Quality Care Coordinator conducts HEDIS and year-round medical record reviews and is responsible for ensuring that Network Health meets all OCI, CMS and NCQA quality requirements. This role will ...

Network Health

Quality Care Coordinator

Brookfield, WI · Hybrid

The Quality Care Coordinator conducts HEDIS and year-round medical record reviews and is responsible for ensuring that Network Health meets all OCI, CMS and NCQA quality requirements. This role will ...

Network Health

Quality Care Coordinator

Brookfield, WI · Hybrid

The Quality Care Coordinator conducts HEDIS and year-round medical record reviews and is responsible for ensuring that Network Health meets all OCI, CMS and NCQA quality requirements. This role will ...

Network Health, Inc

Database Administrator

Menasha, WI · On-site +1

The Database Administrator will design, install, monitor, maintain, and optimize Network Health Plan databases while ensuring high levels of data availability. This position is responsible for ...

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Showing results 21-40

Member Experience Representative I, TPA

Network Health WI

Menasha, WI • On-site

Full-time

Medical

Posted 26 days ago

Job description

Network Health's success is deeply rooted in its mission to build healthy and strong Wisconsin communities. This mission shapes every decision we make, including the selection of individuals who join our growing team.
Our Member Experience Representative team embodies our commitment to Service Excellence and is dedicated to delivering exceptional customer service both verbally and in writing. This role is responsible for consistently providing accurate, courteous, and timely information to members, providers, brokers, and employers while ensuring each interaction reflects professionalism and care.
Individuals in this position are expected to provide timely, accurate, and compassionate support while maintaining compliance with company policies, regulatory requirements, and operational standards. Success in this role requires strong communication skills, critical thinking, problem-solving abilities, and a commitment to delivering positive outcomes that enhance the overall member and provider experience.
We strive to provide amazing service in plain language that our members will understand.
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 with our hybrid workplace model.
Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday.
Check out our 2025 Community Report 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
  • Demonstrate commitment to Network Health's organizational culture, service standards, and member-first philosophy
  • Apply all organizational, regulatory, credentialing, and compliance standards, including policies, procedures, and applicable regulations
  • Respond to and resolve member, provider, broker, and employer inquiries through phone, portal, fax, and email channels
  • Take ownership of each customer inquiry from initial contact through final resolution, ensuring timely and comprehensive follow-up
  • Accurately document all customer interactions, issues, and resolutions in real time for legal, regulatory, and reporting purposes
  • Meet or exceed established departmental performance goals, including speed to answer, call abandonment, member satisfaction, and first call resolution
  • Facilitate referrals and connect customers with appropriate internal departments for escalated concerns, precertification, claims, appeals, or subrogation matters
  • Produce timely and professional written correspondence to support issue resolution
  • Maintain in-depth knowledge of assigned plan documents, Summary Plan Descriptions (SPDs), Administrative Services Agreements (ASA), employer group details, and departmental procedures
  • Research and resolve complex issues across multiple databases while collaborating with internal departments and external vendors
  • Effectively multitask across systems and platforms to ensure accuracy, compliance, and positive member outcomes
  • Conduct outbound calls as necessary to resolve customer issues or provide additional support
  • Educate members on available benefits, programs, and vendor resources to maximize plan value and promote overall wellness
  • Support additional operational or departmental responsibilities as assigned

Job Requirements:
  • High school diploma or equivalent
  • A minimum of three years of customer service experience is preferred.
  • TPA environment, health insurance or healthcare clinic experience is preferred.
  • Telephone experience in a call center setting or phone support role is also preferred.
  • Medical terminology background is a plus
  • Excellent communication skills including the ability to clearly explain complicated subjects
  • 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
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.

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