Customer Service Representative II-Fully Remote at WPS Health Solutions

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Customer Service Rep 2

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 celebrated 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, 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

Our Customer Service Rep 2 will support our members and providers with inquirers through phone, email or secured messaging. And will provide support on benefits, claims, preauthorizations and provider verifications.
Promote and provide excellence in customer service.

How do I know this opportunity is right for me? If you:

  • Would enjoy receiving and responding to telephone, written inquiries regarding status of claims, benefits, coordination of benefits, third-party liability, and eligibility.
  • Have the ability to respond to inquiries concerning general enrollment and verify provider status and pre-service authorization requirements.
  • Can utilize pharmacy benefits system to respond to inquiries related to pharmacy coverage and update approved authorizations.
  • Have high attention to detail and can assist with the collection of customer data for quality purposes to update and enhance product offerings.
  • Want to educate members and providers regarding policies and procedures of health plan.
  • Would enjoy working independently, referring to supervisor for assistance and guidance in handling difficult or unique situations.
  • Provide high quality work product to affect accuracy of benefits and services provided to customer.
  • Have the ability to tailor communications to respond professionally to diverse populations, function independently and in a team setting, and balance multiple tasks simultaneously.
  • Possess expertise in Microsoft Office (Outlook, Word, Excel), internet, intranet, and standard office equipment.

What will I gain from this role?

  • Utilizing excellent verbal and written communication, problem-solving, investigative, and organizational skillsets.
  • Many opportunities to resolve inquiries, as well as strengthen customer relationship with WPS staff and customers.
  • Ability to learn about a multitude of areas including:
    • Benefit design for pharmacy.
    • Internal processing systems, web-based systems, resource systems.
    • Benefits compliance, regulations, policies, and procedures.
  • Experience working in an environment that serves our Nation's military, veterans, Guard and Reserves and Medicare beneficiaries.
  • Working in a continuous performance feedback environment.

Minimum Qualifications

  • COVID-19 vaccination or WPS approval for an accommodation.
  • High School Diploma or equivalent

Preferred Qualifications

  • Familiarity with medical terminology, diagnosis, and procedure codes and/or completion of medical coding class.
  • 1 or more year in managed care insurance as a Claims Customer Service Representative or Claims Processor.
  • Knowledge of coordination of benefits, Medicare primacy, third-party liability, and other regulations related to claims adjudication.

This role is open to 100% remote work for this opportunity in the following approved states:
Approved States: Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, South Dakota, South Carolina, Texas, Virginia, Wisconsin


  • Remote 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 here

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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 contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
More Information on WPS Health Solutions
WPS Health Solutions operates in the Insurance industry. The company is located in Madison, WI, Green Bay, WI, Rothschild, WI, Omaha, NE, West Frankfort, IL and Hampton, VA. WPS Health Solutions was founded in 1946. It has 2082 total employees. It offers perks and benefits such as Flexible Spending Account (FSA), Disability Insurance, Dental Benefits, Vision Benefits, Health Insurance Benefits and Life Insurance. To see all 5 open jobs at WPS Health Solutions, click here.
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