Customer Support Representative

For PACE organizations, and other niche dual eligible health plans, Peak TPA (Third-Party Administration) provides unparalleled services because of the breadth of offerings, integration with electronic medical records (EMRs), and extensive industry experience of its staff. Peak TPA is a Tabula Rasa HealthCare, Inc. company and a CareVention HealthCare solution.

This position requires flexibility to rotate evening or weekend hours, October 1st – March 31st. Only those candidates who are able to meet this requirement will be considered.

Job Description: Customer Support Representative

Summary: Under the supervision of the Customer Support Supervisor, the Customer Support Representative is responsible for answering calls from our clients’ medical provider network and clients’ enrolled members. The Customer Support Specialist will provide timely and accurate responses in a professional and courteous manner utilizing defined processes and guidelines. This position also assists with... various internal tasks that ensure a high level of overall client satisfaction.

Essential Functions:

Responds to provider and member phone inquiries in a timely manner; provides accurate responses in a professional and courteous manner

Researches inquiries using appropriate team members as a resource

Assists team with providing claim status for client inquiries

Follows up with provider and member calls to obtain further information internal departments may request, as needed

Ensures that HIPAA guidelines are followed in every communication with providers, clients or staff

Additional Functions:

Assists with special projects, as requested

Communicates clearly and concisely, with sensitivity to the needs of others

Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees

Maintains courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups. Consistently cooperates and supports organization in problem solving issue

Implements the TRHC 32 Fundamentals in daily work habits and relationships

Establishes and maintains effective working relationships with co-workers

Follows all Policies and Procedures and HIPAA regulations

Participates in any recommended or required training sessions

Maintains a safe working environment

FLSA Status: Non-Exempt

Supervisory Responsibility: None

Travel: None

Knowledge, Skills and Abilities:

Educational requirements include a High School Diploma or equivalent.

Prior customer service experience is required. Two years of professional work experience in a health plan call center is strongly preferred.

Exposure to health plan management operations is preferred

General knowledge of medical terminology preferred

Knowledge and experience using current computer technology

Current working knowledge and extensive use of Excel and Word.

Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels

Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency

Ability to work independently with minimal supervision

Ability to communicate professionally, clearly and effectively, verbally and in writing

Ability to prioritize effectively

Ability to multitask

Physical Demands & Requirements:

Communicates by way of the telephone with providers, participants, customers, and vendors; majority of the workday is spent communicating on the telephone

Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer

Remains stationary for extended periods of time

Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy

Occasional reaching to retrieve shelved items

Occasional bending/stooping

Work Environment:

This job operates in a home or professional office environment with a conversational noise level.

No substantial exposure to adverse environmental conditions is expected.

Moderate pressure to meet scheduled appointments and deadlines

Moderate potential for occasional verbal aggression by providers and clients

#LI-Remote

• **This is a remote position. Adequate internet speeds and a suitable home-office environment are required for this position. All new team members will be bound by the “Teleworking Agreement’ and must continually meet the terms of the agreement to maintain remote work status