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.
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
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
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
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