Network Health

Title: Member Experience Representative I Location: - Menasha, WI 54952, USA - Brookfield, WI 53005, USA Full-time Hybrid 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. The Member Experience Representative I will support our various line of business by addressing benefit interpretations, claims, authorizations, and other member inquiries in a collaborative and innovative environment. This role involves assisting members with their healthcare questions through phone calls and emails, as well as supporting providers with inquiries about Network Health plans. Our Member Experience Representatives embody our commitment to "Service Excellence" by guiding members through their healthcare needs. They help members understand their benefits, resolve claim concerns, locate providers, and serve as a resource for healthcare providers. At Network Health, we strive to deliver a better healthcare experience, ensuring members get the help they need with just one call. We strive to provide amazing service in plain language that our members will understand. The initial training period is a 6-8 week program with a work schedule of Monday - Friday from 8:00 am - 4:30 pm. After your training, you can select a Monday - Friday work schedule of either 8:00 am to 4:30 pm or 8:30 am to 5:00 pm. 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. Brookfield In-Office Support: Employees who are able to work a hybrid schedule in our Brookfield office (16960 W. Greenfield Ave., Suite #5) qualify for an additional $5.00 per hour in recognition of in-office support. Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday. Target Start Date: This position has a target start date of May 18, 2026, or June 1, 2026, contingent upon the candidate's availability to begin employment. 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 and behavior aligned with the philosophy, mission, values, and vision of Network Health. - Apply organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies appropriately. - Efficiently handle incoming phone calls from members, customers, providers, or brokers regarding inquiries related to coverage, claim status, benefit interpretation, billing, and authorizations. Respond to inquiries within established timeframes to meet department metrics and contractual standards. - Proactively ask probing questions during calls to clarify caller concerns and ensure first-call resolution. - Follow up with customers or other departments on outstanding issues to ensure timely resolution. Escalate unresolved issues to the Supervisor or appropriate individual as needed. - Perform other duties 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 - 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

Title: Health Insurance Claims Supervisor Location: Menasha, WI 54952, USA Brookfield, WI 53005, USA Hybrid Claims Production Full-time Requisition #: CLAIM002306 Job Description: Network Health's success is rooted in our mission to enhance the life, health, and wellness of the people we serve. This mission drives every decision we make - including the selection of individuals who join our growing team. We are seeking a Claims Supervisor to provide leadership and oversight of the daily operations within our Claims Production Department, including outsourced vendor management across multiple lines of business. This role plays a critical part in ensuring operational efficiency, regulatory compliance, and high-quality service delivery. The Claims Supervisor will: - Supervise claims production activities and ensure efficient, accurate workflow - Hire, coach, and performance manage team members - Prioritize daily work, departmental initiatives, and special projects - Support the Manager of Claims in driving overall department performance - Serve as a subject matter resource and represent the department in meetings - Lead special projects and respond to emergent operational issues - Ensure compliance with state mandates, regulatory requirements, and internal policies This position requires strong leadership skills, sound judgment, analytical thinking, and a solid understanding of claims operations to maintain operational excellence and support continued organizational growth. 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 2024 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: - Demonstrates commitment and behaviors aligned with the philosophy, mission, values, and vision of Network Health. - Applies organizational, regulatory, and credentialing principles, policies, and procedures to the claims production process. Assists the Manager of Claims Production and/or Manager of Claims Recovery with regulatory reporting and compliance audits, including Data Validation, Financial Audits, and CMS Program Audits. - Monitors and tracks Service Level Agreements (SLAs) and Key Performance Indicators (KPIs), identifies patterns, and escalates issues to leadership as needed. - Supervises assigned claims staff, including hiring, training, performance evaluations, salary recommendations, and managing discipline and termination processes. Collaborates with the Manager of Claims Production on hiring, salary decisions, discipline, and terminations. Provides performance feedback to improve the skills and performance of both claims and claims recovery staff. - Coordinates staffing schedules to maintain optimal staffing levels. Establishes department turnaround times and production rates. Sets departmental priorities and develops efficient workflows to meet objectives. Ensures compliance with desk procedures and regulatory requirements. - Prepares and analyzes daily, weekly, and monthly operational reports, distributing relevant data to appropriate departments. Works with the Manager of Claims Production to set claims-related goals and develop strategies to meet them. - Maintains communication with other Network Health departments to assess and improve the effectiveness of the claims function, including standardizing and documenting policies and procedures, facilitating new policy implementation, and identifying opportunities for internal efficiency improvements. - Recommends and oversees employee training for claims staff. Organizes and leads regular staff and department meetings. - Performs claims-related tasks, such as processing high-dollar claims, monitoring suspended claims reports to ensure timely resolution, and serving as a liaison between the claims department and other departments. Documents results in QNXT, TMG FACETs, TMG Call, and QuickBase applications. - Other duties as assigned. Job Requirements: - Associate Degree or equivalent experience required. Bachelor's degree preferred - One year of experience in a leadership role, preferably in a health insurance industry - At least two years of health insurance claims experience is required Network Health is an Equal Opportunity Employer