About PEAK TPA
Peak TPA is a third party administrator (TPA) that provides back-office functions for capitated health plans. Back-office functions include but are not limited to claims adjudication, member enrollment and reporting, and financial reporting. Peak TPA's partner company, Mediture/Cognify, has a
long history in providing software solutions for managing care coordination for capitated health plans. Both companies (subsidiaries of Tabula Rasa Healthcare Company) work closely together to provide integrated and intuitive products to our health plans.
Peak TPA's goal is to seamlessly handle our client’s back-office
functions to allow the plan to financially thrive and grow so they can focus on
member care coordination.
Summary: The Client Service Representative is a self-motivated, independent, well-organized, flexible, resourceful, and detail-oriented problem solver, with excellent written and verbal communication skills and the ability to balance between multiple, sometimes conflicting, priorities. A “can do” attitude and eagerness to tackle challenges and resolve issues, and the ability to work in a fast-paced environment are required.
Under the supervision of the Client Service Supervisor, the Client Service Representative is primarily responsible for acting as a liaison, main point of contact and problem solver for our clients. The Client Service Representative ensures that issues are resolved in a timely manner, builds relationships with key contacts, and proactively communicates with Peak team members as well as with clients on a number of subjects.
Client Conference Calls
Schedules regular conference calls with assigned Peak clients on a weekly, biweekly, monthly, or quarterly basis
Seeks client agenda items in advance of scheduled call
Seeks agenda items from key Peak stakeholders in advance of scheduled call
Publishes bulleted agenda for each call 24 hours in advance when needed
Facilitates discussion during each call
Takes notes during each call, including actions needed by Peak and by Client, and publishes notes within 24 hours of each call to key Peak stakeholders and the Clients key contacts
Assigns actions, with deadlines, to Peak staff as needed after each call
Updates notes to show completion of actions captured
Establishes and maintains regular communication stream outside of scheduled conference calls; acts as main point of contact for assigned clients
Engages key Peak staff to answer questions, resolve issues presented by clients
Researches issues and applies effective problem solving and communication skills until resolved
Responds to client inquiries in a timely manner
Proactively shares information with clients as well as Peak staff
Escalates issues to management as needed
Reports regularly on trends uncovered through client communication (for a single client as well as across clients)
Additional Job Requirements:
Maintains Client Contact list
Maintains Peak Contact list and provides updates to clients as needed
Ensures customer satisfaction by understanding and applying the Customer Service Policy, Procedure and Standards. Will support the success of the entire Peak team.
Communicates clearly and concisely with sensitivity to the needs of others.
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 issues.
Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees.
Participates in continuing education classes and any required staff and training meetings.
Performs other duties as required or requested in a positive and helpful manner to ensure a smooth-running work area.
Maintains knowledge and understanding of current Medicare regulations related to PACE health plan management.
Follows all Policies and Procedures and OSHA safety guidelines.
Maintains safe working environment.
Travel: Minimal travel, less than 10%, expected for this position
Knowledge, Skills and Abilities:
Education/Experience – Educational requirements include a high school diploma.
Three (3) years of professional work experience in a health plan setting in account management, client relations, claims, or operations is highly preferred
Knowledge and experience using current computer technology, and a strong knowledge of Excel and Word; ability to easily adapt to new systems
Skilled in problem resolution and root cause analysis
Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels
Skilled in establishing and maintaining effective working relationships with clients, vendors, providers and co-workers
Ability to demonstrate resourcefulness and resolve issues in a timely manner
Ability to remain patient and calm in stressful situations
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:
Communicate by way of the telephone with participants, customers, vendors and staff
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
Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects
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 professional or home 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