At Network Health, our mission to enhance the life, health, and wellness of the people we serve drives every decision we make-including the talented individuals we welcome to our growing team.
We are seeking a Workforce Management (WFM) & Experience Excellence Specialist to support our member experience department. This role focuses on optimizing workforce efficiency by monitoring, reporting, and adjusting employees' schedules to ensure the team meets key performance indicators (KPIs). Responsibilities include real-time production monitoring, demand adjustments, intra-day reporting, and schedule updates to maximize utilization across all lines of business.
To align with our vision of delivering exceptional member experiences, this role also involves:
- Conducting competitive intelligence and analysis.
- Executing journey mapping initiatives.
- Leading and coordinating experience excellence projects and process improvements.
- Collaborating with cross-functional business teams to develop innovative, member-focused solutions.
The ideal candidate will have a passion for enhancing the member experience, leveraging insights from member feedback, and driving continual improvement at all levels of the company. If you are a dedicated professional with a member-first mindset and the skills to make a meaningful impact, we invite you to join us in delivering exceptional experiences.
This position will report to our Director of Enterprise Excellence for data collection and reporting.
Essential Job Duties:
* Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health
* Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies
* Demonstrate an organized and accountable approach to daily administrative responsibilities.
* Researches and responds to telephone inquiries according to desk procedures, identify incorrectly processed claims and completes the adjustment and/or reprocessing action according to the Claim department guideline.
* Thoroughly document incoming calls to provide necessary details to team.
* Provides daily support to Member Experience as required to maintain proper KPIs. Adhere to Member Experience departmental policies and to comply with applicable regulations.
* Acts as a subject matter expert and provides support in resolution of complex issues, including working in collaboration with other departments.
* Lead the development of customer research, personas and journey mapping to identify and advocate for the voice of the customer.
* Monitor and report emerging trends and detailed competitive analysis.
* Maintain oversight of projects and operational efficiencies focused on creating excellent member experiences.
* Work with internal business units to help execute prioritized customer experience creation and improvement plans.
* Assists in the work required to build a member focused mindset at Network Health.
* Assists in the execution of a plan that identifies and solves for the creation of excellent member experiences and strategic opportunities in collaboration with stakeholders.
* Drives to serve as a relentless advocate for the customer, as well as a desire to seize the opportunity to be part of the ground up development of a new strategic capability for Network Health.
* Performs other duties and responsibilities as assigned.
* Other duties as assigned.
Minimum Education Required:
Associate's degree or a combination of experience and education preferred.
Minimum Related Years of Experience (per minimum education) Required:
- 2 years of experience as a member experience representative or experience in the insurance and customer focused industry.
- Excel experience with intermediate knowledge of formula definitions
- Able to use critical thinking and problem solving skills with ability to multi-task and demonstrate strong organizational skills.
- Effective verbal and written communication and interpersonal skills.
- Proficient knowledge of insurance terminology including current procedural terminology (CPT) and international classification of diseases (ICD-10) and medical terminology.
Candidates must reside in the state of Wisconsin for consideration.
We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce
Network Health
Jan 04, 2025