Remote Health Plan Support Specialist

WPS Health Solutions; Atlanta (GA); Teletrabalho; USD 23 000 - 33 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Remote work options

Performance bonus

401(k) with match

Paid time off

Health insurance

Professional development

Resumo da oferta

WPS Health Solutions is hiring a Customer Care Center Rep to deliver exceptional service to members, brokers, and providers. You will research answers across multiple systems and respond with clear, accurate information regarding benefits, eligibility, and claims.

The role requires staying updated on health plan products, documenting interactions, and maintaining compliance with HIPAA and CMS. Training is provided; remote work is allowed in approved states, including Georgia.

Qualificações

• High School Diploma or GED or equivalent experience.
• 1+ years of customer service in a fast-paced health insurance or healthcare call center environment.
• Strong verbal and written communication skills with the ability to explain complex information.
• Demonstrated problem-solving skills with empathy and patience.
• Solid ability to multitask, prioritize, and manage time effectively in a fast-paced environment.
• Ability to maintain a high level of accuracy and attention to detail.
• Proficiency in Microsoft Office Suite and website/portal navigation.
• Ability to adhere to a structured work schedule based around the central time zone.

Responsabilidades

• Serve as the first point of contact for members, brokers, and medical providers regarding benefits, eligibility, claims, billing, and healthcare services.
• Assist members in understanding their benefits, eligibility, claim status and the resolution of billing issues.
• Respond to provider inquiries related to claims, authorizations, and reimbursement status.
• Address and resolve service requests, complaints and issues efficiently, ensuring high levels of customer satisfaction.
• Collaborate with internal teams to address complex inquiries and facilitate a seamless experience.
• Review detailed information across multiple systems to accurately resolve inquiries while delivering clear, professional, and thorough responses.
• Accurately document all interactions in the system for follow-up actions and QA purposes.
• Develop a thorough understanding of health plan products and services, and stay updated on policies and regulatory requirements.
• Ensure adherence to regulatory guidelines (HIPAA, CMS) when providing information and service.

Conhecimentos

Verbal communication

Written communication

Empathy

Multitasking

Attention to detail

Time management

Formação académica

High School Diploma or GED or equivalent experience

Ferramentas

Microsoft Office Suite

Descrição da oferta de emprego

WPS Health Solutions is hiring a Customer Care Center Rep to deliver exceptional service to members, brokers, and providers. You will research answers across multiple systems and respond with clear, accurate information regarding benefits, eligibility, and claims.

The role requires staying updated on health plan products, documenting interactions, and maintaining compliance with HIPAA and CMS. Training is provided; remote work is allowed in approved states, including Georgia.