Medicare Customer Service Rep
WPS—A health solutions company, Virginia, MN, United States
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: 5/19/2026
Starting hourly rate: $19.60/hour (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 can start as early as 6:55 AM or as late as 8:30 AM CST; 8 hours, based on business need
Work from Home: 100% remote opportunity within approved remote worker states
Approved remote worker states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin.
Are You a Good Fit?
Can provide responses to provider calls relating to Part A and/or Part B general inquiries, Part A Appeals Status, Part B Reopenings, and/or Part A and Part B provider enrollment inquiries.
Would enjoy assisting and educating providers on Medicare regulations, utilizing CMS guidelines 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 processing systems such as MCSDT, FISS, CWF, SNAP, PECOS, OnBase, MAS, and CRM.
Like to work with internal and external customers to obtain information required to resolve inquiry‑related issues consistently.
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 maintain CMS performance requirements.
Want to ensure adherence to regulatory guidelines (HIPAA, CMS) when providing information 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 explain complex information clearly.
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
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.
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).
Review Remote Worker FAQs for additional information.
Benefits
Remote 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.
Additional benefits information: https://www.wpshealthsolutions.com/careers/.
Who We Are WPS is a health solutions company and a leading not‑for‑profit health insurer and federal government contractor headquartered in Madison, Wisconsin. We provide health insurance plans, process claims, and support beneficiaries of the Medicare program across the U.S. and abroad. Proud to be military and veteran ready.
Culture Drives Our Success WPS’ culture empowers employee experience, drives innovation, and leverages diverse perspectives to adapt to business changes. Our commitment to recognition includes various national awards.
This position supports services under Centers for Medicare & Medicaid Services (CMS) contracts and is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies. CMS contractors must undergo screening and background investigation including fingerprinting prior to accessing information systems.
#J-18808-Ljbffr
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: 5/19/2026
Starting hourly rate: $19.60/hour (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 can start as early as 6:55 AM or as late as 8:30 AM CST; 8 hours, based on business need
Work from Home: 100% remote opportunity within approved remote worker states
Approved remote worker states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin.
Are You a Good Fit?
Can provide responses to provider calls relating to Part A and/or Part B general inquiries, Part A Appeals Status, Part B Reopenings, and/or Part A and Part B provider enrollment inquiries.
Would enjoy assisting and educating providers on Medicare regulations, utilizing CMS guidelines 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 processing systems such as MCSDT, FISS, CWF, SNAP, PECOS, OnBase, MAS, and CRM.
Like to work with internal and external customers to obtain information required to resolve inquiry‑related issues consistently.
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 maintain CMS performance requirements.
Want to ensure adherence to regulatory guidelines (HIPAA, CMS) when providing information 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 explain complex information clearly.
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
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.
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).
Review Remote Worker FAQs for additional information.
Benefits
Remote 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.
Additional benefits information: https://www.wpshealthsolutions.com/careers/.
Who We Are WPS is a health solutions company and a leading not‑for‑profit health insurer and federal government contractor headquartered in Madison, Wisconsin. We provide health insurance plans, process claims, and support beneficiaries of the Medicare program across the U.S. and abroad. Proud to be military and veteran ready.
Culture Drives Our Success WPS’ culture empowers employee experience, drives innovation, and leverages diverse perspectives to adapt to business changes. Our commitment to recognition includes various national awards.
This position supports services under Centers for Medicare & Medicaid Services (CMS) contracts and is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies. CMS contractors must undergo screening and background investigation including fingerprinting prior to accessing information systems.
#J-18808-Ljbffr