Medicare Customer Service Rep

WPS Health Solutions New • Madison, WI

9d • Remote

About The Position

Our Medicare Customer Service Rep plays a critical role in providing responses to telephone inquiries from medical providers or representatives related to a wide range of Medicare topics involving Part A (hospital insurance) and/or Part B (medical insurance). They are accountable to educate customers on coverage, claim submission, and use of self-service offerings. Success is accomplished by navigating multiple systems to research and resolve inquiries with a clear, accurate, and easy to understand response. Preference will be given to those that have Medicare and call center experience. Additional Information Start Date: 8/25/26 Starting hourly rate : $19.60/hour and may vary based on county SCA rates. Training Location/Schedule: Mandatory Training - First 5 weeks Monday-Friday from 7:30 AM – 4:05 PM Central Standard Time (CST) Scheduled Shift: After training - Shifts can start as early as 6:55 or as late as 8:30 AM CST and are 8 hours. This is based off business need. Work from Home: This is a 100% remote opportunity within any of our approved remote worker states. We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin

Requirements

• High School Diploma or GED or equivalent.
• 1 or more years of customer service experience working with health insurance and / or Medicare.
• Ability to function in a fast paced, high volume call center environment
• Proficiency in Microsoft Office Suite and customer service software.
• Strong verbal and written communication skills with the ability to effectively explain complex information.
• Solid ability to multitask, prioritize, and manage time effectively in a fast-paced environment.
• Ability to maintain a high level of accuracy and attention to detail.
• 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

• Medicare and call center experience
• 1 or more years of Medicare customer service experience and/or claims processing.
• Solid knowledge of Medicare Part A and/or Part B program guidelines.
• Solid knowledge of insurance, medical coding and medical terminology.

Responsibilities

• Provide responses to provider (and other third-party contacts) calls relating to Part A and/or Part B General Inquiries, Part A Appeals Status, Part B Reopening’s, and/or Part A and Part B Provider Enrollment Inquiries.
• Assist and educate providers on Medicare regulations on inquiries by utilizing CMS guidelines, publications, and reference materials to ensure correct claim submission.
• Enroll providers with recurrent concerns or errors into contact programs for intensive education.
• Maintain knowledge of A and/or B processing systems and applications required for job functions, including Multi-Carrier System Desktop (MCSDT), Fiscal Intermediary Shared System (FISS), Common Working File (CWF), CMS Secure Net Access Portal (SNAP), Provider Enrollment Chain and Ownership System (PECOS), OnBase, Medicare Appeals System (MAS,) and Customer Relations Management System (CRM).
• Work with internal and external customers to obtain information required to respond to and ensure consistency in the resolution of inquiry-related issues.
• Assist the department in meeting CMS performance and award fee metrics and all quality and quantity standards.
• Support other departments within the division as needed, to ensure CMS performance requirements are maintained.
• Ensure adherence to regulatory guidelines (i.e., HIPAA, CMS) when providing information and can service to members and providers.

Benefits

• Remote work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs

What This Job Offers

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