Medicare Customer Service Rep II

WPS Health Solutions; Charleston (SC); Remote; USD 10,000 - 60,000; Full time

Job summary

An established industry player is seeking a dedicated customer service representative to join their remote team. In this role, you will be responsible for responding to inquiries from providers, educating them on coverage and claims processes, and ensuring a positive experience for all contacts. This position offers the opportunity to enhance your knowledge of Medicare guidelines while working in a supportive environment recognized for its excellence in customer service. Join a team that values your contributions and offers competitive benefits, including health insurance starting on day one and a robust 401(k) plan.

Benefits

Remote Work Options

Performance Bonus Opportunities

401(k) Matching

Competitive Paid Time Off

Health and Dental Insurance

Professional Development Programs

Qualifications

• 1+ years of customer service experience in health insurance.
• Ability to learn and apply insurance and medical terminology.

Responsibilities

• Respond to provider inquiries via telephone.
• Educate customers on coverage and claims submission.

Skills

Customer Service

Knowledge of Medicare Guidelines

Communication Skills

Problem-Solving

Computer Navigation

Education

High School Diploma or Equivalent

Job description

Description

This position will respond to telephone inquiries from provider or representatives. Establish and maintain rapport with contacts and present a favorable corporate image. Educate customers on coverage, claim submission, and use of self-service offerings.

• Receive and respond to a wide range of provider inquiries received via the telephone.


• Educate providers on coverage, claim submission, and use the self-service offerings available via the Integrated Voice Response (IVR) and Portal.

Additional Information

• Start Date: Tuesday, June 17^th, 2025


• Starting Pay: $19.60/hour


• Training Schedule: First 6 weeks Monday-Friday 7:30am-4:05pm CST


• Scheduled Shift: Monday-Friday 8:30am-5:05pm CST


• 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:
Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin

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

• Ability to learn and apply Medicare guidelines and computer-based self-service tools.


• Knowledge of or ability to learn and apply insurance and medical terminology.


• Ability to identify customers issues, research, and initiate appropriate action. *Ability to communicate with confidence and clarity when discussing concerns with customers.


• Ability to navigate through multiple computer applications.


• Ability to ask probing questions to identify issues.

What will I gain from this role?

• Enhanced learning of Medicare guidelines.


• Being part of a successful team. The GHA Contact Center was awarded Best Small Contact Center by the International Customer Management Institute (ICMI).


• Experience working in an environment that serves our Nation's military, veterans, Guard and Reserves and Medicare beneficiaries


• Continuous performance feedback

Minimum Qualifications

• High School diploma or equivalent

• 1 or more years of customer service experience working with health insurance and/or Medicare/DME claims.


• 1 or more years of customer service experience with direct contact with customers via telephone

Preferred Qualifications

• 1 or more years of previous customer service experience at WPS OR Experience working as a contracted Medicare CSR II at WPS.


• 1 or more years recent Medicare or health care insurance experience


• 2 or more years of call center experience


• Coursework in coding and/ or medical terminology or understanding of general medical terminology.


• Coursework in Business Administration, Communications, or related field.

Remote Worker Requirements: For remote position, employee is required to meet remote worker requirements, including a designated workstation, a wired (Ethernet) connection to the network, and a minimum of 10Mbps downstream connection with at least 1Mbps upstream (can be checked at https://speedtest.net)

Benefits

• Remote and hybrid 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


• Professional and Leadership Development Programs


• Review additional benefits: (https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml)

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' Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique 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.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.