Homeoffice Medicare Customer Service Rep chez WPS Health Solutions

Role Snapshot
Our Medicare Customer Service Rep plays a critical role in providing responses to telephone inquiries from medical providers or representatives related to a wide range of Medicare topics involving Part A (hospital insurance) and/or Part B (medical insurance). They are accountable to educate customers on coverage, claim submission, and use of self-service offerings. Success is accomplished by navigating multiple systems to research and resolve inquiries with a clear, accurate, and easy to understand response.

Additional Information

• Start Date: Tuesday November 4^th 2025
• Starting hourly rate: $19.60/hour and may vary based on county SCA rates.
• Training Location/Schedule: Mandatory Training - First 5 weeks Monday-Friday from 7:30 AM – 4:05 PM Central Standard Time (CST)
• Scheduled Shift: After training - Shifts are flexible with options starting between 6:55 AM and 8:30 AM CST and are 8 hours.
• Work from Home: This is a 100% remote opportunity within any of our approved remote worker states.

We are open to remote work in the following approved states:
Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin

How do I know this opportunity is right for me?  If you:

• Can provide responses to provider (and other third-party contacts) calls relating to Part A and/or Part B General Inquiries, Part A Appeals Status, Part B Reopening’s, and/or Part A and Part B Provider Enrollment Inquiries.
• Would enjoy assisting and educating providers on Medicare regulations on inquiries by utilizing CMS guidelines, publications, and reference materials to ensure correct claim submission.
• Can enroll providers with recurrent concerns or errors into contact programs for intensive education.
• Would like to maintain knowledge of A and/or B processing systems and applications required for job functions, including Multi-Carrier System Desktop (MCSDT), Fiscal Intermediary Shared System (FISS), Common Working File (CWF), CMS Secure Net Access Portal (SNAP), Provider Enrollment Chain and Ownership System (PECOS), OnBase, Medicare Appeals System (MAS,) and Customer Relations Management System (CRM).
• Like to work with internal and external customers to obtain information required to respond to and ensure consistency in the resolution of inquiry-related issues.
• Can assist the department in meeting CMS performance and award fee metrics and all quality and quantity standards.
• Would enjoy supporting other departments within the division as needed, to ensure CMS performance requirements are maintained.
• Want to Ensure adherence to regulatory guidelines (i.e., HIPAA, CMS) when providing information and can service to members and providers.

Minimum Qualifications

• High School Diploma or GED or equivalent.
• 1 or more years of customer service experience working with health insurance and / or Medicare or Durable Medical Equipment Claims.
• Ability to function in a fast paced, high volume call center environment
• Proficiency in Microsoft Office Suite and customer service software.
• Strong verbal and written communication skills with the ability to effectively explain complex information.
• 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.

 Preferred Qualifications

• Solid knowledge of Medicare Part A and/or Part B program guidelines.
• Solid knowledge of insurance, medical coding and medical terminology.
• 1 or more years of Home, Health, and Hospice (HH&H) customer service experience and/or claims processing.

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer
• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
• Please review Remote Worker FAQs for additional information

 Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
•  Employee Resource Groups
• Professional and Leadership Development Programs
•  Review additional benefits: (https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml)

Who We Are

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS’ culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace:  WPS Newsroom - Awards and Recognition.

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This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s).  As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services