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Customer Care Specialist, Pay is $15.78/hr, Start Date-Sept 27th (Must be located within 45 miles of Madison, WI WPS campus) at WPS Health Solutions

Posted in Other 30+ days ago.

Location: Madison, Wisconsin

Job Description:


Role Summary

Answer inquiries from beneficiaries, providers, and other affiliated representatives or groups regarding TRICARE eligibility, benefit determinations, and claims adjudication questions or problems.

In this role you will:

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

  • Apply appropriate provisions of TRICARE 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 of TRICARE 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.

This role could be a good fit if you:

  • Excel at providing timely, accurate answers via telephone by employing strong listening skills

  • Enjoy new challenges and approach each day with a positive attitude

  • Demonstrate a strong work ethic with a history of dependability and respect

  • Possess excellent information retention capabilities

  • Thrive in an environment that offers opportunities for continuous learning

You'll benefit from this experience by:

  • Gaining experience working in a call center environment

  • Having the ability to work remotely from home

  • Building in-depth communication and customer service skills

  • Being part of a fun, supportive team that offers great advancement opportunities throughout the organization

  • Working in an environment that serves our Nation's military, veterans, Guard and Reserves along with their families

You need to have:

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

  • High school diploma or equivalent

  • 2 or more years of experience in customer service

  • Ability to learn medical and insurance terminology

We also prefer:

  • Microsoft Office Experience

  • Ability to navigate dual monitor screens and between multiple programs at once

  • Strong skillsets in multi-tasking, research, and problem-solving

Next steps:

  • After submitting your application, we will send you an online assessment. We recommend you complete it within 1-2 business days. You must complete and obtain a passing score on the assessment to be considered for the position.

Additional Information:

  • Start Date: Monday, September 27, 2021

  • Starting Base Salary: $15.78/hr

  • Training Schedule: 8:25am-5:00pm CST Monday-Friday until late December

  • Scheduled Shift: Starting December 20th, schedule will be determined by shift bids for 8- hour shifts ending between 6-10 pm CST, Monday-Friday

  • Work from Home: 100% remote, including training, must reside within a 45-mile radius of Madison, WI WPS campus (remote status based on continued satisfactory work performance). This is a bargaining unit position.

  • For remote position, employee is required to meet remote worker requirements, including a designated work station, a wired (Ethernet) connection to the network, and a minimum of 10Mbps downstream connection with at least 1Mbps upstream (can be checked at

Compensation and Benefits

  • Eligible for annual merit-based increases

  • 401(k) with dollar-per-dollar match up to 6% of salary

  • Competitive paid time off

  • Health and dental insurance start DAY 1

  • Vision insurance

  • Flexible spending, dependent care, and health savings accounts

  • Short- and long-term disability, group life insurance

  • Innovative professional and cognitive development programs

Who We Are

WPS Health Solutions is an innovator in health insurance and a worldwide leader in claims administration, serving millions of beneficiaries in the United States and abroad.

Founded in 1946, WPS offers health insurance plans for individuals, families, and seniors, and group plans for small and large businesses. We are a world-class claims processor and program administrator for the government's Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.

Learn more about WPS.

Our Purpose and Values

Our purpose is to make healthcare easier for those we serve. Click Here

Our values - Customer Focused, Individual Responsibility, Mutual Respect, and Driven & Passionate - are the core of who we are and how we conduct business every day.

WPS Health Insurance

WPS Health Insurance offers high-quality health insurance plans for individuals and families, Medicare supplement plans for seniors, and group health plans for businesses of every size.

Military and Veterans Health

WPS Military and Veterans Health administers claims and provides customer service and related activities for the U.S. Department of Defense and the U.S. Department of Veterans Affairs and their beneficiaries.

Government Health Administrators

WPS Government Health Administrators manages Medicare Part A and Part B benefits for more than 7 million beneficiaries. As one of the largest contractors for the Centers for Medicare & Medicare Services, we've served Medicare beneficiaries and their health care providers since 1966.

WPS Health Plan

WPS Health Plan offers Health Maintenance Organization and Point-of-Service plans to the group and individual markets in eastern and north-central Wisconsin, plus third-party administrator services.

EPIC Specialty Benefits

EPIC Specialty Benefits provides businesses group insurance products that cover:

  • Life

  • Disability

  • Dental

  • Vision

  • Voluntary benefits

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
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