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Customer Service Rep III , starting pay $15.02 + shift differentials

Company: WPS Health Solutions
Location: Madison
Posted on: February 16, 2020

Job Description:

Role Summary:

If you have a mindset for great customer service, now is your chance to take advantage of this skillset while directly serving active military, veterans, and their families! Answer inquiries from beneficiaries, providers, and other affiliated representatives or groups regarding TRICARE eligibility, benefit determinations, and claims adjudication questions or problems. Establish and maintain rapport with contacts and present a favorable corporate image while responding to inquiries within time frames required to exceed contractual standards.

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.

    This role could be a good fit if you:

    • Possess a customer-service mindset and enjoy conversing with customers over the phone
    • Are a proactive learner with an inquisitive mind who asks questions and seeks out resources and opportunities for ongoing growth
    • Have the passion and willingness to learn medical and insurance terminology
    • Thrive in a supportive, fast-paced work environment

      You'll benefit from this experience by:

      • Gaining experience working in a call center environment and learning contract compliance
      • Building in-depth communication skills
      • Working within a fun, supportive team that offers great advancement opportunities throughout the organization
      • Working remotely once all training is complete and performance expectations are met
      • Receiving medical and dental benefits starting on 1st day of employment
      • Being a part of an environment that serves our Nation's military, veterans, Guard and Reserves along with their families."Serving those who serve us"

        You need to have:

        U.S. citizenship is required for this position due to U.S. Department of Defense restrictions.

        • High school diploma or equivalent
        • 2 years of experience in customer service or related field
        • Ability to learn medical and insurance terminology

          We also prefer:

          • Medical Insurance Experience
          • Recent Military and Veterans Health claims processing with knowledge of TRICARE benefits and guidelines, system applications, medical terminology, and procedure codes

            Next steps:

            • After submitting your application, we will send you a customer service online assessment if you have not already completed one. We recommend you try and complete it within two business days. You must complete and obtain a passing score on the assessment to be considered for the position.

              Compensation and Benefits

              • Starting base salary $15.02 + shift differentials
              • Eligible for annual Merit increases
              • 401(k) withdollar-per-dollar match up to 6% of salary
              • Competitive paid time off
              • Health and dental insurance startDAY 1
              • Vision insurance
              • Flexible spending, dependent care, and health savings accounts
              • Short- and long-term disability, group life insurance
              • Dress for your day
              • Innovative professional and cognitive development programs

                Additional Information:

                • Training Schedule:First 4 weeks, Monday- Friday, 8:00am- 4:35pm (duration subject to change)
                • Scheduled Shift: Different shifts available
                • Work from Home: Remote potential is determined once training is complete. Employee must be performing well in the position and able to meet the at-home work requirements.

                  Who We Are

                  WPS Health Solutions is an innovator in health insurance and a worldwide leader in claims administration, serving millions of beneficiaries in the United States and abroad.

                  Founded in 1946, WPS offers health insurance plans for individuals, families, and seniors, and group plans for small and large businesses. We are a world-class claims processor and program administrator for the government's Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.

                  WPS has been named one of theWorld's Most Ethical Companies-- by the Ethisphere-- Institute for 10 years in a row.

                  Learn more about WPS.

                  Our Purpose and Values

                  Our purpose is to make healthcare easier for those we serve.Click Here

                  Our values- Customer Focused, Individual Responsibility, Mutual Respect, and Driven& Passionate- are the core of who we are and how we conduct business every day.

                  Health Insurance

                  WPS Health Insurance offers high-quality health insurance plans for individuals and families, Medicare supplement plans for seniors, and group health plans for businesses of every size.

                  http://wpshealthsolutions.com/business-units/wpshi.shtml

                  Military and Veterans Health

                  WPS Military and Veterans Health administers claims and provides customer service and related activities for the U.S. Department of Defense and the U.S. Department of Veterans Affairs and their beneficiaries.

                  http://wpshealthsolutions.com/business-units/wpsmvh.shtml

                  Government Health Administrators

                  WPS Government Health Administrators manages Medicare Part A and Part B benefits for more than 7 million beneficiaries. As one of the largest contractors for the Centers for Medicare& Medicare Services, we've served Medicare beneficiaries and their health care providers since 1966.

                  http://wpshealthsolutions.com/business-units/wpsgha.shtml

                  Arise

                  Arise Health Plan provides innovative and high-value health plans to groups and individuals in eastern and northeastern Wisconsin. With our quality Wisconsin-based customer service, Arise offers health care expertise with a personal touch.

                  http://wpshealthsolutions.com/business-units/arise.shtml

                  EPIC Specialty Benefits

                  EPIC Specialty Benefits provides businesses group insurance products that cover:

                  • Life
                  • Disability
                  • Dental
                  • Vision
                  • Voluntary benefits

                    http://wpshealthsolutions.com/business-units/epicsb.shtml

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Keywords: WPS Health Solutions, Madison , Customer Service Rep III , starting pay $15.02 + shift differentials, Sales , Madison, Wisconsin

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