Customer Service Team Lead

Tres Health is redefining healthcare with innovative solutions aimed at transforming the industry. The Customer Service Team Lead plays a critical role in supporting the launch and ongoing development of Tres Health's new Customer Service department, partnering closely with the Customer Service Manager to establish daily operations and workflows.

Responsibilities:

• Partner with the Customer Service Manager to support the launch and implementation of the new Customer Service department, including call flows, procedures, and knowledge resources
• Serve as the first point of contact for Customer Service Representative questions and escalations, providing real-time guidance during daily operations
• Coach and mentor Customer Service Representatives on call handling, documentation accuracy, member/provider experience, and efficiency
• Handle escalated provider and member inquiries requiring additional research, including eligibility, benefits, claims, provider network, and authorization questions
• Assist providers with claim status, claim research, and complex issue resolution beyond first-tier support
• Assist members with benefit questions, provider searches, ID card support, and healthcare navigation for escalated concerns
• Ensure all member and provider interactions follow HIPAA and company compliance guidelines
• Support department performance goals, including Average Handle Time (AHT), Average Speed of Answer (ASA), abandonment rate, Quality Assurance (QA), First Call Resolution, and customer satisfaction
• Assist with call reviews and quality evaluations, providing feedback and coaching to improve agent performance
• Monitor trends and recommend training opportunities to reduce escalations and improve first call resolution
• Support system testing, workflow validation, and operational readiness ahead of go-live
• Other tasks as assigned

Requirements:

• Minimum 5+ years healthcare customer service experience required
• Strong understanding of eligibility and benefits, claims processing lifecycle, Explanation of Benefits (EOBs), provider inquiries, medical terminology, prior authorizations, healthcare networks, and HIPAA compliance
• Strong leadership, coaching, and communication skills, with a problem-solving mindset and ability to manage competing priorities
• Minimum 2+ years experience as a Team Lead, Senior Representative, Subject Matter Expert, Trainer, or similar leadership role preferred
• Previous experience supporting healthcare insurance, TPA operations, health plans, or provider services strongly preferred
• Experience assisting with a new department launch, system implementation, or process improvement project preferred
• Experience training or mentoring Customer Service Representatives preferred
• Knowledge of self-funded employer health plans preferred
• Experience with CRM/contact center platforms such as Zendesk, NICE CXone, or similar systems preferred
• Experience creating or maintaining SOPs, job aids, or knowledge resources preferred