Customer Service Representative II

• Location 5520 Nobel Drive,Suite 125,Fitchburg, WI, 53711,United States
• Base Pay $21.00 - $22.50 / Hour
• Job Category Customer Service, Health Care Provider, Administrative
• Industry Insurance, Hospitals and Health Care, Health and Human Services
• Employee Type Non-Exempt
• Required Degree High school
• Manage Others No

• Name Employee Experience at The Alliance
• Phone
• Email employee experience@the-alliance.org

Customer Support & Advocacy

• Maintains a positive and approachable demeanor in all customer interactions, showing a genuine interest in helping consumers and improving their experience.
• Helps member employees navigate their health insurance network providers.
• Independently provides customer service via telephone and email, answering questions and resolving issues related to electronic claims filing, repricing, network-related inquiries, and other established Customer Services processes.
• Refers consumers to the appropriate third-party administrator (TPA) or other resource for claims status, eligibility, or matters requiring assistance outside The Alliance’s scope.
• Provides education and resources to empower consumers to make informed health care decisions.
• Responds to written correspondence within established time frames.

I ssue Resolution & Collaboration

• Researches customer questions and concerns using available systems and resources and identifies appropriate solutions or next steps.
• Independently resolves standard customer issues and determines when additional expertise, referral, or escalation is appropriate.
• Takes ownership of customer inquiries and supports timely follow-through and resolution.
• Accurately documents customer interactions, research, actions taken, and relevant information to support continuity of service.
• Collaborates with Customer Services staff, other departments, and appropriate external partners to resolve customer issues.

Customer Insights & Continuous Improvement

• Proactively collects and shares consumer feedback to identify recurring concerns and opportunities to improve the customer experience.
• Recognizes patterns in customer inquiries and communicates observations to the Director or other appropriate Alliance staff.
• Contributes ideas and feedback that support improvements to Customer Services processes, resources, and service delivery.
• Maintains proficient knowledge of The Alliance’s networks, services, systems, terminology, and Customer Services processes.
• Assists with data entry and other departmental responsibilities as needed.

• High school diploma or equivalent.
• Demonstrated customer service experience with the ability to independently manage a broad range of customer inquiries and concerns.
• Working knowledge of health care networks, claims, eligibility, repricing, and related Customer Services processes.
• Ability to research and resolve moderately complex customer issues by gathering information from multiple systems, resources, or departments.
• Strong judgment and problem-solving skills, including the ability to determine appropriate next steps and recognize when escalation is necessary.
• Ability to explain complex or unfamiliar information to consumers in a clear, understandable, and supportive manner.
• Strong verbal and written communication skills with demonstrated accuracy and professionalism.
• Ability to manage challenging customer interactions while maintaining composure, empathy, and a high standard of service.
• Ability to identify patterns or recurring customer issues and communicate observations that may improve processes or the customer experience.
• Ability to work effectively across departments to facilitate issue resolution.
• Demonstrated reliability in managing workload, documentation, follow-up, and…