Remote Health Plan Support Specialist

WPS Health Solutions; Denver (CO); Remote; USD 23,000 - 33,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) match

Health insurance starting day 1

Job summary

WPS Health Solutions is seeking a Customer Care Center Rep to deliver exceptional service to members, brokers, and providers. You will research inquiries using multiple systems, provide clear and accurate responses, and ensure regulatory compliance.

The role offers a starting base salary of $20.50/hr with CST training hours and a standard CST schedule once fully trained. Remote work is available in approved states, including Colorado, and benefits start on day one.

Qualifications

• High School Diploma or GED or equivalent experience.
• 1+ year of customer service experience in a fast paced, high-volume health insurance or healthcare call center environment.
• Strong verbal and written communication skills with the ability to effectively explain complex information.
• Demonstrated problem-solving skills with the ability to handle difficult situations 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 and/or portal navigation.
• Ability to adhere to a structured work schedule based around the central time zone.

Responsibilities

• Serve as the first point of contact for members, brokers, and medical providers, answering inquiries 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 (both written, and verbal), that are easy to understand by a diverse population.
• Accurately document all interactions in the system, ensuring thorough record-keeping for follow-up actions and quality assurance purposes.
• Develop a thorough understanding of health plan products and services, actively learning updates to policies, procedures, and regulatory requirements.
• Ensure adherence to regulatory guidelines (i.e., HIPAA, CMS) when providing information and service to members, providers or brokers.
• Other job-related responsibilities may be assigned as required.

Skills

Customer service

Communication

Multitasking

Microsoft Office

Web portal navigation

Education

High School Diploma or GED

Tools

Facets

NTT

Job description

WPS Health Solutions is seeking a Customer Care Center Rep to deliver exceptional service to members, brokers, and providers. You will research inquiries using multiple systems, provide clear and accurate responses, and ensure regulatory compliance.

The role offers a starting base salary of $20.50/hr with CST training hours and a standard CST schedule once fully trained. Remote work is available in approved states, including Colorado, and benefits start on day one.