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.
Job Description: Member Service Representative
Summary: Under the supervision of the Director of Client and Provider Relations, the Member Service Representative is responsible for answering calls from our clients’ enrolled members and providing timely and accurate responses in a professional and courteous manner. This position also assists with various internal tasks that ensure a high level of overall client satisfaction.Essential Functions:
Responds to 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
Follows up as needed to relay claim status or obtain further information
Assists team with providing claim status for client inquiries
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 issues.
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
Supervisory Responsibility: None
Travel: Minimal travel, less than 10%, expected for this positionKnowledge, Skills and Abilities:
Educational requirements include a High School Diploma or equivalent. One year of professional work experience required, preferably in a health plan setting.
Previous call center experience preferred
General knowledge of medical terminology preferred
Knowledge and experience using current computer technology, and a strong knowledge 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 have superior attendance to fulfill all position functions
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 work day 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
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/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