Job Details
** Customer Service Representative, fully remote, Start date March 28th**
**Job Category****:** Customer Service **Requisition Number****:** CUSTO004889 Showing 1 location **Job Details**
**Description**
**Who We Are**
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 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, WPS Health Solutions was recognized for several awards including:
**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.
* 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
* 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 Nations 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
* Ability to learn medical and insurance terminology
* COVID-19 vaccination or WPS approval for an accommodation
**Preferred Qualifications**
* 2 or more years of experience in customer service, preferably a call center environment
* 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:** Tuesday March 28th, 2022
* **Starting Base Salary:** $15.47/hr (SCA applies)
* **Training Schedule:** 8:25am-5:00pm CST Monday-Friday until late June 2022
* **Scheduled Shift:** In late June, schedule will be determined by shift bids for 8- hour shifts ending between 6:00am-11:00pm CST, Monday-Friday
* **Work from Home:** 100% remote, including training
* For remote position, employee is required to meet remote worker requirements, including a designated work station, a wired (Ethernet) connection to the network, and a minimum of 10Mbps downstream connection with at least 1Mbps upstream (can be checked at
**Next steps**
After submitting your application, we will send you an online assessment. We recommend you try and complete it within two business days of receiving the assessment invitation. You must complete and obtain a passing score on the assessment to be considered for the position.
**Benefits**
* Remote and hybrid work options available
* Performance bonus and/or merit increase opportunities
* 401(k) with **dollar-per-dollar match up to 6% of salary** (100% vested immediately)
* Competitive paid time off
* Health, dental insurance, Teladoc starts **DAY 1**
* Review additional benefits
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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractors legal duty to furnish information. 41 CFR 60-1.35(c)