Team Lead – Member and Provider Service

🕒 3 days ago

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Peak Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

📋 Description

• 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. • Monitor progress towards specialist readiness. • Leads training efforts and ensures all updates to materials. • 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. • 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. • Coordinate other service support activities as assigned by the manager.

🎯 Requirements

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

🏖️ Benefits

• Health insurance • 401(k) matching • Professional development opportunities