Medicare Customer Service Rep

About the role

The role involves responding 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).

Responsibilities

• Respond 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.
• Utilize CMS guidelines, publications, and reference materials to ensure correct claim submission.
• Enroll providers with recurrent concerns or errors into contact programs for intensive education.
• 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).
• Work with internal and external customers to obtain information required to respond to and ensure consistency in the resolution of inquiry-related issues.
• Support other departments within the division as needed, to ensure CMS performance requirements are maintained.
• Ensure adherence to regulatory guidelines (i.e., HIPAA, CMS) when providing information and servicing to members and providers.

Requirements

• High School Diploma or GED or equivalent.
• 1 or more years of customer service experience working with health insurance and / or Medicare.
• 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.
• Able to maintain a high level of accuracy and attention to detail.
• 1 or more years of Medicare customer service experience and/or claims processing.
• Solid knowledge of Medicare Part A and/or Part B program guidelines.
• Solid knowledge of insurance, medical coding and medical terminology.

Skills

• Knowledge of A and/or B processing systems and applications required for job functions.
• Ability to navigate multiple systems to research and resolve inquiries.
• Experience with customer service software.
• Strong communication skills.
• Ability to multitask and prioritize.
• Attention to detail.
• Knowledge of Medicare Part A and/or Part B program guidelines.
• Knowledge of insurance, medical coding and medical terminology.

Benefits

• 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.

Who We Are

We are WPS, a health solutions company, headquartered in Madison, Wisconsin. We offer 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.

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Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.