Team Lead- Member and Provider Service

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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.
The Team Lead, Peak Health Member and Provider Service is a primary contact for employees and managers within Peak Health Service. In addition to the Team lead reviewing and monitoring general customer and provider inquiries via chat, calls, and service requests, they will be a point of contact for employee escalations and ensure customer satisfaction. As a subject matter expert in Peak Health, the Team Lead will be accountable for new team member training to ensure specialists are competent in WVUHS and Peak Health policies and processes of the Peak Health Service team. This position will be a foundational experience for anyone looking to move into Management.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. 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:

1. Three (3) years of call center service environment experience.

2. Two (2) years of experience with service technologies including telephony, chat, CRM management, knowledge management, training, and documentation.

3. Two (2) years of health insurance, medical environment experience.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s Degree, or greater, in related healthcare field.

EXPERIENCE:

1. One (1) year of experience with Peak Health Member and Provider Service

2. Five (5) years of service experience, preferably in call center environment.

3. Three (3) to (5) years’ experience in health insurance.

4. Three (3) years’ experience in commercial, Medicare, and Medicaid plans.

5. Three (3) years of working in a metric driven environment.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Serve as a point of escalation for member and provider service manager calls.

2. Serves as a single point of contact for higher level of support inquires for Peak Health.

3. Participate in meetings with other Peak Health departments to stay current on actions affecting Customer Service and Insurance workflows.

4. Acts as a mentor to new team members and ensures new team member competency of policy and procedures of the role.

5. Monitor progress towards specialist readiness.

6. Leads training efforts and ensures all updates to materials.

7. Collaborate with team leadership to align the team with department and corporate goals through training and process management.

8. Regularly review escalated service requests for correct assignment, identifying activities that can become Customer Service knowledge areas.

9. Responsible for ensuring appropriate coverage for chat inquires and call coverage during lunch.

10. 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.

11. Provide input and guidance to managers and employees regarding understanding of Peak Health policies, procedures, forms, and processes.

12. Answer inquiries by clarifying desired information; research, locate and provide information.

13. Resolve problems by clarifying issues; research and explore answers, and alternative solutions; escalate unresolved problems to supervisor

14. Anticipate and responds to customer needs; follows up until needs are met.  Maintains proactive contact with customers to ensure awareness of service request status until resolution.

15. Coordinate other service support activities as assigned by the manager.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to sit for extended periods of time.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)

2. Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC.

SKILLS & ABILITIES:

1. Exceptional customer service skills.

2. Ability to execute in a fast paced, high demand, environment while balancing multiple priorities.

3.  Effective interpersonal skills.

4. Familiarity with Health Insurance practices and procedures

5. Ability to manage call volume and reduce the number of abandoned calls to improve team performance metrics.

6. Excellent written and oral communication skills

7. Proficiency with MS Office, Tapestry and other computer applications as required

8. Ability to utilize search tools and knowledgebase tools to find relevant information.

9. Exercise good judgment in handling sensitive and confidential information and situations

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

PHH Peak Health Holdings

Cost Center:

2911 PHH Member Services