Customer Service Representative

Customer Service Representative (ASO)

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.

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.

Other Experience and Qualifications:

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.