Team Lead- Member and Provider Service

About the role

Come join our Peak Health team at WVU Medicine as a Team Lead for Member and Provider Service, contributing to the foundation for an innovative, new health plan. This position will report to the Service Manager, playing a unique and important role in our mission to change healthcare for the better.

Responsibilities

• Serve as a point of escalation for member and provider service manager calls.
• Serves as a single point of contact for higher level of support inquires for Peak Health.
• Participate in meetings with other Peak Health departments to stay current on actions affecting Customer Service and Insurance workflows.
• Acts as a mentor to new team members and ensures new team member competency of policy and procedures of the role.
• Maintain proactive contact with customers to ensure awareness of service request status until resolution.
• Collaborate with team leadership to align the team with department and corporate goals through training and process management.
• Regularly review escalated service requests for correct assignment, identifying activities that can become Customer Service knowledge areas.
• Responsible for ensuring appropriate coverage for chat inquires and call coverage during lunch.
• Respond to chats, calls and service requests from employees, managers in a timely manner with a customer focus and with the goal to resolve 90% of the inquiries on first contact.
• Provide input and guidance to managers and employees regarding understanding of Peak Health policies, procedures, forms, and processes.
• Answer inquiries by clarifying desired information; research, locate and provide information.
• Resolve problems by clarifying issues; research and explore answers, and alternative solutions; escalate unresolved problems to supervisor.

Requirements

• MINIMUM QUALIFICATIONS:
• EDUCATION, CERTIFICATION, AND/OR LICENSURE: High school diploma or equivalent AND five (5) years of experience in customer service support OR Associate degree AND three (3) years of experience in customer service support OR Bachelor’s degree AND two (2) years of experience in customer service support.
• EXPERIENCE: Three (3) years of call center service environment experience. Two (2) years of experience with service technologies including telephony, chat, CRM management, knowledge management, training, and documentation. Two (2) years of health insurance, medical environment experience.

PREFERRED QUALIFICATIONS

• EDUCATION, CERTIFICATION, AND/OR LICENSURE: Bachelor’s Degree, or greater, in related healthcare field.
• EXPERIENCE: One (1) year of experience with Peak Health Member and Provider Service Five (5) years of service experience, preferably in call center environment. Three (3) to (5) years’ experience in health insurance. Three (3) years’ experience in commercial, Medicare, and Medicaid plans. Three (3) years of working in a metric driven environment.

Skills & Abilities

• Exceptional customer service skills.
• Ability to execute in a fast paced, high demand, environment while balancing multiple priorities.
• Effective interpersonal skills.
• Familiarity with Health Insurance practices and procedures.
• Ability to manage call volume and reduce the number of abandoned calls to improve team performance metrics.
• Excellent written and oral communication skills.
• Proficiency with MS Office, Tapestry and other computer applications as required.
• Exercise good judgment in handling sensitive and confidential information and situations.

Additional Job Description

Scheduled Weekly Hours: 40 Exempt/Non-Exempt: Shift: United States of America (Non-Exempt) Company: PHH Peak Health Holdings Cost Center: 2911 PHH Member Services