Job Details
Description
Customer Service Representative, Fully Remote, Start Date November 14th
Who We Are
WPS Health Solutions is a leading not-for-profit health insurer in Wisconsin. Our services offer health insurance plans for individuals, families, seniors, and group plans for small to large businesses. We process claims and provide customer service support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. In 2021, WPS Health Solutions celebrates 75 years of making health insurance easier for those we serve. Proud to be military and veteran ready.
Our Culture
WPS’ Performance-Based Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive, empowering employee experience, focusing on People, Work, and Conditions. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. We are guided by our Purpose: Together, making health care easier for the people we serve.
In 2021 & 2022, WPS Health Solutions was recognized for several awards including:
- Madison, Wisconsin’s Top Workplaces
- Top Workplace national cultural excellence awards for Remote Work and Work-Life Flexibility
- Achievers 50 Most Engaged Workplaces® with the further honor of Achievers “Elite 8” winner in the category of Culture Alignment
Role Snapshot
Answer inquiries from beneficiaries, providers, and other affiliated representatives or groups regarding TRICARE eligibility, benefit determinations, and claims adjudication questions or problems.
In this role you will:
- Receive telephone, written, fax, and e-mail inquiries concerning TRICARE eligibility, benefits determinations, and claims adjudication questions or billing problems.
- Apply appropriate provisions of TRICARE regulations, interpretations, and procedural directives in making determinations on eligibility and benefits to determine appropriate responses to inquiries.
- Obtain and analyze claims data to determine specific problem area including external communication to obtain data.
- Complete research and provide final resolution to inquiries within contractual requirements.
- Communicate with inquirer to determine appropriate authorization or referral of services.
- Submit claims for adjudication, correction, payment, or review as appropriate.
- Educate providers on billing requirements of TRICARE to reduce claim problems.
- Deal tactfully with people in a wide variety of situations to convey a favorable corporate image.
- Respond to inquirer using various forms of communication (written letter, telephone, web, or email) within time frames to exceed contractual standards.
- Collect and record data for Customer Service records and computer analysis.
- Inform supervisory staff of system problems when identified, researching problems to provide backup data and examples when needed.
How do I know this opportunity is right for me? If you:
- Enjoy working in a high-volume call center
- Excel at providing timely, accurate answers via telephone by employing strong listening skills
- Enjoy new challenges and approach each day with a positive attitude
- Demonstrate a strong work ethic with a history of dependability and respect
- Possess excellent information retention capabilities
- Thrive in an environment that offers opportunities for continuous learning
What will I gain from this role?
- Gaining experience working in a call center environment
- Having the ability to work remotely from home
- Building in-depth communication and customer service skills
- Being a part of a fun, supportive team that offers great advancement opportunities throughout the organization
- Working in an environment that serves our Nation’s military, veterans, Guard and Reserves along with their families
Minimum Qualifications
- U.S. citizenship is required for this position due to Department of Defense restrictions
- High school diploma or equivalent
Preferred Qualifications
- 2 or more years of experience in customer service
- Ability to learn medical and insurance terminology
- Microsoft Office Experience
- Ability to navigate dual monitor screens and between multiple programs at once
- Strong skillsets in multi-tasking, research, and problem-solving
Additional Information
- Start Date: Monday, November 14th, 2022
- Starting Base Salary: $18.00/hr
- Training Schedule: The first 2 months will consist of training until December. The training shifts will go from 8:25am-5:00pm CST Monday-Friday.
- Scheduled Shift: In late January, schedule will be determined by shift bids for 8 – hour shifts starting between Monday 4:55am-Friday 9:00pm CST (later evening or overnight shift may be required for a short period of time)
- Location: Work from home 100% remote, including training.
- For remote position, employee is required to meet remote worker requirements, including a designated workstation, a wired (Ethernet) connection to the network, and a minimum of 10Mbps downstream connection with at least 1Mbps upstream (can be checked at https://speedtest.net)
- To help strengthen communication, provide a sense of community, and improve the overall remote work experience, the assigned office community based on the position’s division is: Hampton, VA