Medicare Customer Service Rep II

WPS Health Solutions; Town of Texas (WI); 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. This role focuses on responding to provider inquiries and educating them on coverage and claims. Ideal candidates will possess strong communication skills and a willingness to learn about Medicare guidelines. Join a supportive environment that values diversity and innovation, while making a significant impact in the healthcare sector. Enjoy the benefits of remote work and be part of a team recognized for its excellence in customer service.

Benefits

401(k) with matching

Health Insurance

Paid Time Off

Performance Bonuses

Professional Development Programs

Remote Work Options

Dental Insurance

Telehealth Services

Qualifications

• At least 1 year of customer service experience in health insurance.
• Ability to learn Medicare guidelines and use self-service tools.

Responsibilities

• Respond to provider inquiries via telephone.
• Educate providers on coverage and claim submission.

Skills

Customer Service

Insurance Knowledge

Communication Skills

Problem-Solving

Computer Proficiency

Education

High School Diploma

Job description

This position will respond to telephone inquiries from providers or their representatives. It involves establishing and maintaining rapport with contacts and presenting a favorable corporate image. The role also includes educating customers on coverage, claim submission, and the use of self-service offerings.

1. Receive and respond to a wide range of provider inquiries received via telephone.
2. Educate providers on coverage, claim submission, and the self-service options available via the Integrated Voice Response (IVR) system 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 approved remote worker states.

Approved remote work states include: 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.

Ideal Candidate:

• Ability to learn and apply Medicare guidelines and use computer-based self-service tools.
• Knowledge of or ability to learn insurance and medical terminology.
• Ability to identify customer issues, research, and initiate appropriate actions, communicating confidently and clearly.
• Proficiency in navigating multiple computer applications.
• Skill in asking probing questions to identify issues.

Benefits of the Role:

• Enhanced knowledge of Medicare guidelines.
• Participation in a successful team, awarded Best Small Contact Center by ICMI.
• Experience serving military, veterans, Guard, Reserves, and Medicare beneficiaries.
• Continuous performance feedback.

Minimum Qualifications

• High School diploma or equivalent.
• At least 1 year of customer service experience with health insurance and/or Medicare/DME claims.
• At least 1 year of customer service experience via telephone.

Preferred Qualifications

• Experience at WPS or as a contracted Medicare CSR II at WPS.
• Recent Medicare or healthcare insurance experience.
• 2+ years of call center experience.
• Coursework in medical coding, terminology, business administration, or communications.

Remote Work Requirements: Must meet remote workstation standards, including a wired Ethernet connection with minimum speeds of 10Mbps downstream and 1Mbps upstream (test at https://speedtest.net).

Benefits Include:

• Remote and hybrid work options.
• Performance bonuses and merit increases.
• 401(k) with immediate 100% vesting on the first 3% match and 50% on the next 2%.
• Paid time off, health insurance, dental, telehealth from day 1.
• Professional and leadership development programs.
• Additional benefits at https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml.

About Us: WPS Health Solutions is a non-profit health insurer and federal contractor based in Wisconsin, serving individuals, families, seniors, and military personnel for over 75 years.

Our Culture: We foster an open, empowering employee environment that values diversity, innovation, and authentic self-expression. Recognized for our workplace culture, we aim to create a high-performing, inclusive team.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. For rights info, review the Know Your Rights notice from the Department of Labor.