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Who We Are
We are a leading not-for-profit health insurer in Wisconsin, and our services have grown to reach active-duty and retired military personnel, seniors, and families in Wisconsin, across the U.S., and around the world. Learn more!
WPS receives World's Most Ethical Company Award for 9th Year in a Row - 2018 Most Ethical Companies Announcement
At Our Core
WPS Health Solutions has earned a reputation as a leader in the insurance and benefits administration industry through our commitment to excellence and high-quality service. Our corporate values reflect the core of who we are and how we conduct business every day.
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Customer Focused I recognize how my actions impact internal and external customers by being responsible for the customer experience. I look beyond the immediate issue to recognize and solve the problem. |
Individual Responsibility I own my actions. I am accountable and dedicated to achieving the best results for WPS Health Solutions and our customers. I embrace my role in helping the company achieve a high-performance workplace. |
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Mutual Respect I lead by example and act ethically, honestly and am trustworthy. I show appreciation for others by giving and taking constructive feedback and encouragement. |
Driven and Passionate I approach my work with enthusiasm, and personal commitment to the success of our business. I keep the importance of the work we do for our customers alive in my attitude and interactions with others, and demonstrate pride in the worthiness of our purpose. |
Position Summary
In this position you will answer inquiries from beneficiaries, providers, and other affiliated representatives or groups regarding eligibility, benefit determinations, and claims adjudication questions or problems. You will establish and maintain rapport with contacts and present a favorable corporate image while responding to inquiries within time frames required to exceed contractual standards. We offer remote work after training and up to 60 days maximum of being productive on the floor. We also will soon have pay for performance incentives as well!!!
In this role you will:
- Receive telephone, written, fax, and e-mail inquiries concerning eligibility, benefits determinations, and claims adjudication questions or billing problems.
- Apply appropriate provisions of 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 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.
You should have:
- High school diploma or equivalent
- 2 or more years of experience in customer service
In addition, we prefer:
- Recent Military and Veterans Health claims processing with knowledge of Veterans Affairs benefits and guidelines, system applications, medical terminology, and procedure codes
Anticipated Shift: We are looking to fill our 10:25-7:00 pm shift. (Earlier shift times available based on experience)
Start Date: We are looking to hire 20 candidates for our VA Team starting 2/25 in Wausau, WI. This position starts at 13.77 an hour plus a $0.50 premium per hour for shift differential.
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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer.