Customer Service Representative II (Call Center-REMOTE)

Who We Are

WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer 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. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready.

Culture Drives Our Success

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 and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce—both current and future—to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

From 2021 to 2023, WPS Health Solutions was recognized for several awards:

• Madison, Wisconsin’s Top Workplaces
• USA Top Workplaces and the 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
• DAV Patriot Employer
• VETS Indexes 4 Star Employer
• BBB Torch Award for Ethics from Better Business Bureau of Wisconsin

Role Snapshot

Our Customer Service Representative II works in our WPS Health Insurance call center. This role will support our members and providers with inquirers through phone, email, or secured messaging. In addition, this role will provide support on benefits, claims, pre-authorization’s and provider verifications.

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.
• 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 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.
• 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.
• Working in a continuous performance feedback environment.
• Experience working in an environment that serves our Nation’s military, veterans, Guard and Reserves and Medicare beneficiaries.

Minimum Qualifications

• High School Diploma or equivalent

Preferred Qualifications

• 1 or more years of experience working with WPS HI systems and processes.
• 1 or more years of current WPS call center experience is strongly preferred
• 2 or more years of experience in customer service.
• 1 or more years of experience with healthcare benefits expertise
• 1 or more years of experience working in a remote setting.
• 1 or more years of experience working in a call center.
• 1 or more years of experience in managed care insurance / healthcare benefits as a Customer Service Representative or Claims Processor.
• Knowledge of coordination of benefits, Medicare primacy, third-party liability, and other regulations related to claims adjudication.

Remote Work Requirements

• 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)
• Please review Remote Worker FAQs for additional information

Additional Information

• Start Date: Monday, May 6th, 2024
• Star ting Base Salary : at least $ 20.50/hour
• Training Location/Schedule: Mandatory Training. Monday-Friday from 8-4:30pm CT
• Scheduled Shift: Once trained, 8-hours shifts between 7:30am-5pm CT

Work Location

• We are a remote-first organization and offer remote work in the following approved states:
  Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin
  • To help strengthen communication, provide a sense of community, and improve the overall remote work experience, the assigned office community based on the position’s division is: HI: Green Bay, Wisconsin

Benefits

• 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 insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs
• 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)