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Customer Service Representative-Seasonal


Job Summary

This role responds to telephone inquiries from providers or representatives. Establish and maintain rapport with contacts and present a favorable corporate image. Educate customers about coverage, claim submission, and use of self-service offerings. We have 7 Seasonal Openings, apply today!

Start Date: 10/16/17

Hours: Monday - Friday: 8:30 AM - 5:00 PM

Characteristics and Responsibilities
  • Respond to telephone inquiries from customers on claim processing, billing, and coverage issues not answered by integrated voice response (IVR) or interactive self-service technology.
  • Research Provider Inquiry electronic work processes and reference manuals to provide accurate responses to inquiries. Complete any follow up action as required.
  • Log all inquiries and document/update clearly and accurately inquiry tracking system.
  • Assist and educate providers on Medicare regulations by utilizing CMS guidelines, publications, and reference materials to ensure correct claim submission.
  • Deal tactfully and persuasively with internal and external customers. Respond to all customers in a polite and courteous manner and demonstrate professionalism while working with difficult customers and/or issues of a sensitive nature.
  • Refer unusual or complex inquiries to Senior Customer Service Representatives.
  • Meet requirements of Federal Privacy Act, ISO 9000, Freedom of Information, Desk Disclosure Reference, and WPS conflict of interest and confidentiality.
  • Identify and refer potential fraudulent providers and/or beneficiaries to Complaint Screening.
  • Refer misdirected phone calls and unusual claims aberrancies to appropriate area for handling.
  • Assist department in meeting CMS performance metrics and quality and quantity standards, supporting other Medicare areas as needed.
  • Provide technical assistance by identifying and reporting system problems, and testing new enhancements and other changes as released.


Work Experience

  • 1 or moreyears recent Medicare experience
  • Ability to learn and apply Medicare Program guidelines and computer-based self-service tools
  • Knowledge of or ability to learn and apply insurance and medical terminology
  • Ability to identify customers issues, research, and initiate appropriate actions
  • Ability to problem-solve through research and analysis of issues



  • High school diploma or equivalent
  • Completion of a 4-6 week training program in addition to 3 months on-the-job training is required upon hire

  • Post high school coursework in Business Administration, Communications, or related field
  • Completion of medical terminology course or an understanding of general medical terminology

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