Customer Service Rep, Pay is $17.75/hr, 2nd Shift position - 10:25am - 7:00pm CS - (Must live within vicinity of Madison, WI WPS campus location)

WPS Health Solutions New • Madison, WI

6d • Hybrid

About The Position

The successful candidate will play a critical role in providing call center telephone support, as well as responses to written inquiries submitted by, military members, retirees, and dependents eligible for both TRICARE and Medicare benefits. In addition, this role is responsible for assisting with claims and billing inquiries from hospitals and clinics. Inquiries can include questions about claims, benefits, and eligibility. Success is accomplished by navigating multiple systems to research and resolve complex inquiries with a clear, accurate, and easy to understand response. This is a Bargaining Unit / Union position. This position supports services under U.S. Department of Defense (DoD) Defense Health Agency (DHA) contract(s). As such, the role is subject to all applicable federal regulations, DoD contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. DoD contractors and their personnel are subject to screening and background investigation prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services.

Requirements

• U.S. citizenship is required for this position due to Department of Defense restrictions.
• Must live within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI, 53713).
• High school diploma or equivalent.
• 2 or more years of experience in customer service (Call Center).
• Ability to learn medical and insurance terminology.
• Wired (ethernet cable) internet connection from your router to your computer
• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net )

Nice To Haves

• Expertise in Microsoft Office (Outlook, Word, Excel), internet, intranet, office equipment, and data entry.
• Ability to navigate dual monitor screens and between multiple programs at once.
• Strong skillsets in multi-tasking, research, and problem-solving.
• Ability to work independently, deescalate situations with agitated individuals, control difficult situations, as well as influence and motivate others to comply with TRICARE procedures.

Responsibilities

• 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 areas including external communication to obtain data.
• Complete research and provide final resolution to inquiries within contractual requirements.
• Communicate with inquirers 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 inquirers 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.

Benefits

• 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 insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED