JOB SUMMARY
The Member Experience Representative engages with members and providers to promote positive relations and provide support for incoming expressions of dissatisfaction and member appeals, including addressing questions, concerns and problems related to member experience. The Member Experience Representative acts as a neutral party in sensitive care concerns and member experience by actively listening, instilling trust and confidence, and conveying professionalism to the member(s), or provider(s). The individual communicates and demonstrates to the member, member’s authorized representative, and/or provider the concern and responsiveness of the organization in serving the unique health care needs of the individual. The Member Experience Representative provides member and provider experience support Health Plan wide.
JOB QUALIFICATIONS
EDUCATION
For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.
Minimum Required: Completion of a medical assistant or health unit coordinator program or an Associate degree in a healthcare related field.
Preferred/Optional: Working knowledge of Security Health Plan operations.
EXPERIENCE
Minimum Required: Five years of direct member care or healthcare operations experience to include member interaction on the telephone. Working knowledge of medical terminology and anatomy and physiology.
Preferred/Optional: None
CERTIFICATIONS/LICENSES
The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.
Minimum Required: Certification, license or registration required based on degree/diploma
obtained.
Preferred/Optional: None
Primary functions include working with the Quality team, members and internal staff specific to appeal case entry, processing and completion.
Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.
At Marshfield Clinic Health System, we are fully committed to addressing health equity, diversity and inclusion for our employees and providers, our patients, and the communities we serve. We believe that every individual should have the opportunity to attain their highest level of health. We embrace diversity and welcome differences in who we are and how we think. We believe that any individual or group should feel welcomed, respected and valued. View our Equity and Inclusion Statement here.Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.
Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.