Member Services Representative

Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER

Full time position with the opportunity to work remote/virtual or hybrid after successful completion of a 6-month probationary period. Applicants must reside locally and in Wisconsin to be available for on-site meetings and trainings.

The Member Services Representative serves as the primary resource person responding to members and providers benefits, claims, referral and clinic services inquiries. This position assists members with the resolution of complaints including interviewing of complainants, investigation of the complaint and reporting the details of complaints to internal staff as appropriate. In addition, the Member Services Representative is responsible for departmental data entry and maintenance of files/records as needed. The incumbent functions under the general guidance, direction and supervision of the Member Services Manager.

The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner. The incumbent understands our Mission, Vision and Common Values (stated below) and is committed to promote these values in behavior and attitude.

Our Mission Statement: To provide accessible, comprehensive, high quality healthcare and outstanding service in an efficient and personalized manner on a prepaid basis to persons in the GHC-SCW service area.
Our Vision: To be a leader among HMO’s in providing high-quality medical care, impeccable service and competitive benefit levels and premium rates.

Our Common Values:

• Patient Centered: When health insurers and health care providers are brought together under one roof, we are better together. Our care team model focuses on supporting the needs of our patients/members and providing the best in safe, high quality coordinated health care. Members and their providers participate in making meaningful decisions that lead to better outcomes.
• Quality Driven: When members and their providers each participate meaningfully in the decisions that lead to better health care, we are better together. GHC-SCW continues its tradition of providing proactive health promotion and disease management outreach to our members to consistently achieve high quality health care accreditation.
• Innovation: When we work to lift each other up, show appreciation and collaborate in the best interests of the member, we are better together. GHC-SCW has made innovative advancements which include the implementation of an electronic medical records system (EMR) and GHC-SCW MyChartSM, access to innovative Complementary Medicine benefits and Wellness reimbursement services.
• Community Involved: When we join with our community to further the causes for which we share a common concern, we are better together. We are proud to promote programs that strengthen lives, and make our community a safer, stronger and healthier place to live and grow. GHC-SCW employees share their time and talent; and we recognize that the value of what we give is also what we gain – for our employees, our members and our community.
• Not for Profit Cooperative: When we share a common purpose, a common voice and a common vision, we are better together. We use our surpluses to improve clinics, enhance health care benefits and give back to the community. Our members, not our profits, are our priority. We have a unique “cooperative” governance structure which works directly for our members.

GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.

We believe:
Healthcare is a human right.
In treating all people with dignity and respect.
There is strength in diversity.
Equity celebrates our humanity.

JOB SPECIFIC QUALIFICATIONS

1. High school education or equivalent required
2. Minimum of two (2) years experience in a responsible public contact position required. Experience with an insurance, HMO, or healthcare related operation is desirable but not required.
3. Knowledge of or ability to learn GHC-SCW benefit plans and clinic operations required.
4. Knowledge of and basic ability to use various computer software including Microsoft Office and email.
5. Ability to use and/or learn on-line information systems such as EPIC.
6. Excellent verbal communication and listening skills both in-person and on the phone required. Strong written communication skills.
7. Ability to be culturally sensitive and to work with a diverse patient population. Ability to maintain telephone etiquette.
8. Ability to act in a professional manner when dealing with practitioner staff, personnel of other departments, fellow employees and the general public required.
9. Ability to maintain patient and organizational confidentiality required. Knowledge of or ability to learn HIPAA requirements.
10. Ability to diplomatically handle communications in potentially stressful situations.
11. Excellent problem solving (investigating/explaining) skills required.
12. Excellent record keeping/organizational skills required.
13. Excellent interpersonal skills required.
14. Ability to work independently and manage time well required.
15. Ability to handle multiple projects simultaneously required.
16. Ability to type 35 wpm accurately required.
17. Ability to lift from arm to floor level and occasionally carry bulky loads ranging from 2-15 lbs required.
18. Ability to speak and hear on the telephone and in person required.

19. Physical agility in standing, stooping, kneeling, crouching, reaching (above shoulder, over 18" and to floor), handling and fingering required.

Group Health Cooperative of South Central Wisconsin is proud to be an equal opportunity employer. GHC-SCW considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.