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 a 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
Ability to learn medical and insurance terminology
We also prefer:
2 or more years of experience in customer service, preferably a call center environment
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: $15.47/hr (may be slightly below or above based on location)
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
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 https://speedtest.net)
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
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.
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.
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.
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 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.
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)
