MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High school diploma or equivalent and five (5) years of experience in customer service support.
OR
2. Associate degree and three (3) years of experience in customer service support.
OR
3. Bachelor’s degree and two (2) years of experience in customer service support.
EXPERIENCE:
1. Four (4) years of service environment experience.
2. Two (2) years 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. Two (2) years 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. Position requires availability Monday through Friday, 8:00 a.m. to 5:00 p.m. and weekends as needed for Medicare coverage.
2. Provides high-quality instruction grounded in adult-learning methodologies, leveraging multiple training approaches to effectively engage learners and achieve learning objectives.
3. Delivers and manages a comprehensive six-week new hire training curriculum, ensuring all required topics are completed as scheduled and learning objectives are met.
4. Reviews and evaluates call quality, identifies performance trends and areas of opportunity, and delivers structured feedback to staff and leadership to enhance service quality, compliance, and operational performance.
5. Designs and updates of healthcare call-center training materials and staff development programs, leveraging call quality audits, performance outcomes, and CMS guidelines to enhance instructional effectiveness and support compliance and operational goals.
6. Provides one-on-one coaching and facilitates team refresher trainings addressing conflict resolution, adaptability, and time management, identifying performance gaps and providing targeted developmental support to improve call quality, compliance, and member experience.
7. Serves as a single point of contact for higher level of support inquiries for Peak Health.
8. Serve as a point of escalation for member and provider service manager calls, with other team leads.
9. Participate in meetings with other Peak Health departments to stay current on actions affecting Customer Service and Insurance workflows.
10. Acts as a mentor to new team members and ensures new team member competency of policy and procedures of the role.
11. Collaborate with team leadership to align the team with department and corporate goals through training and process management.
12. Respond to chats, calls and service requests from employees and managers in a timely manner with a customer focus and with the goal resolving 90% of the inquiries on first contact.
13. Answer inquiries by clarifying desired information; research, locate and provide information.
14. Resolve problems by clarifying issues; research and explore answers, and alternative solutions; escalate unresolved problems to supervisor.
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 AND 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:
40Shift:
Exempt/Non-Exempt:
United States of America (Non-Exempt)Company:
PHH Peak Health HoldingsCost Center:
2902 PHH Claims Operations