Medicaid Member Specialist

🌟 Member Experience Representative – Healthcare Customer Service

📍 Remote (First 90 Days) → Hybrid in Brookfield or Menasha, WI

Are you passionate about helping others navigate the complexities of healthcare? Do you thrive in a fast-paced, service-driven environment?

🩺 What You’ll Do

As a Member Experience Representative, you’ll be the first point of contact for members, providers, and brokers—resolving inquiries related to:

• Coverage and benefits
• Claims and billing
• Authorizations and prior approvals
• Medicare, Medicaid, and Marketplace plans

You’ll handle calls and emails with empathy and accuracy, striving for first-call resolution while documenting interactions and collaborating with internal teams to ensure member satisfaction.

🔍 Key Responsibilities

• Answer inbound calls and emails regarding insurance coverage, claims, billing, and authorizations
• Translate healthcare jargon into clear, member-friendly language
• Investigate and resolve issues, escalating when necessary
• Document all interactions and follow-up actions in the system
• Stay current on policies, procedures, and insurance regulations
• Use dual monitors and multiple systems to research and resolve inquiries
• Protect member privacy and comply with HIPAA standards

✅ What You Bring

Required:

• 2+ years of healthcare customer service or call center experience
• Experience with Medicare, Medicaid, or insurance verification
• Ability to multitask in a high-volume environment
• Intermediate Microsoft Office skills (Outlook, Excel, Word)
• Comfortable with hybrid work (3 days onsite in Brookfield or Menasha after 90 days)

💼 Work Environment & Schedule

• 🏠 Remote for first 90 days
• 🏢 Hybrid after conversion: 3 days onsite, 2 days remote
• 📍 Locations:
  • Brookfield
  • Menasha
• 🕗 Monday–Friday, 8:00 AM–4:30 PM
• 👔 Dress Code: Business casual (business professional on first day)
• 💵 $2.50/hour in-office stipend (for full-week onsite support)

🌱 Why Join Us?

• 📈 Career Growth: Internal mobility and advancement opportunities beyond Member Services
• 💰 Wage Escalator: Performance-based raises after hire
• 🧠 Continuous Learning: Stay current with insurance trends and systems
• 🤝 Mission-Driven Culture: Work for a company that values service, integrity, and community

📣 Important Notes

• This is a contract-to-hire role with conversion after 90 business days
• Candidates must be open to hybrid work in either Brookfield or Menasha
• We are ramping up to support new Medicaid and Dental lines of business launching in 2026

Ready to make a difference in healthcare?

Apply today and help us deliver exceptional experiences to the members who count on us.