WPS Health Group

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Customer Service Representative - Start Date: October/November 2019

at WPS Health Group

Posted: 9/29/2019
Job Status: Full Time
Job Reference #: 392bdf39-9633-401b-82f7-94441cf38e7a

Job Description

Who We Are

We are a leading not-for-profit health insurer in Wisconsin, and our services have grown to reach active-duty and retired military personnel, seniors, and families in Wisconsin, across the U.S., and around the world. Learn more!

WPS receives World's Most Ethical Company Award for 10th Year in a Row 2019 Most Ethical Companies Announcement

At Our Core

WPS Health Solutions has earned a reputation as a leader in the insurance and benefits administration industry through our commitment to excellence and high-quality service. Our corporate values reflect the core of who we are and how we conduct business every day.

Customer Focused

I recognize how my actions impact internal and external customers by being responsible for the customer experience. I look beyond the immediate issue to recognize and solve the problem.

Individual Responsibility

I own my actions. I am accountable and dedicated to achieving the best results for WPS Health Solutions and our customers. I embrace my role in helping the company achieve a high-performance workplace.

Mutual Respect

I lead by example and act ethically, honestly and am trustworthy. I show appreciation for others by giving and taking constructive feedback and encouragement. 

Driven and Passionate

I approach my work with enthusiasm, and personal commitment to the success of our business. I keep the importance of the work we do for our customers alive in my attitude and interactions with others, and demonstrate pride in the worthiness of our purpose.

Position Summary

The Customer Service Representative III will answer inquiries from beneficiaries, providers, and other affiliated representatives or groups regarding eligibility, benefit determinations, and claims adjudication questions or problems. You will 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:

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

  • Receive telephone, written, fax, and e-mail inquiries concerning eligibility, benefits determinations, and claims adjudication questions or billing problems.
  • Apply appropriate provisions of 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 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.

You should have:

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

In addition, we prefer:

  • Recent claims processing with knowledge of medical terminology and procedure codes

Additional Details:

  • Start Date: September 9, 2019
  • Shifts: 1st, 2nd and 3rd shift coverage needed
  • Remote Potential: Ability to work remote in the state of WI after formally trained/signed off by manager. 
  • Assessment: Upon receipt of application, you will receive an email with a link to complete an online assessment. Please complete the assessment within 2 business days. Completion of the assessment is a requirement to be considered for the position. 

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