Customer Service Team Lead

Tres Health is redefining healthcare with innovative solutions aimed at transforming the industry. The company specializes in providing nationwide ACA-compliant alternative health plans, supplemental GAP insurance, and advanced digital health technologies. Committed to elevating access to quality care while driving cost-efficiency, Tres Health delivers solutions designed to meet diverse needs. The organization is dedicated to creating impactful healthcare models that empower individuals and organizations alike. Position Summary The Customer Service Team Lead plays a critical role in supporting the launch and ongoing development of Tres Health's new Customer Service department. This role partners closely with the Customer Service Manager to establish daily operations, workflows, service standards, and a best-in-class member and provider experience. The Team Lead provides frontline support to Customer Service Representatives, assists with training and coaching, handles escalated member and provider inquiries, and helps identify process improvement opportunities as the department transitions customer service operations internally. The ideal candidate is an experienced healthcare customer service professional with strong leadership skills, healthcare insurance knowledge, and the ability to succeed in a growing environment where processes and procedures are still being developed. 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. Qualifications Minimum 5+ years healthcare customer service experience required. 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. Strong understanding of eligibility and benefits, claims processing lifecycle, Explanation of Benefits (EOBs), provider inquiries, medical terminology, prior authorizations, healthcare networks, and HIPAA compliance. 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. Strong leadership, coaching, and communication skills, with a problem-solving mindset and ability to manage competing priorities. Work Schedule & Remote Work Full-time, remote position aligned with U.S. business hours. Flexibility required for critical project deadlines, cross-functional meetings, and occasional travel (0–10%) for team collaboration or vendor engagements. Remote Work Requirements Dedicated home office with reliable, high-speed internet. Secure workspace aligned with HIPAA security standards (device encryption, secure Wi-Fi, screen privacy). Ability to effectively coordinate and lead projects in a fully remote environment. Security, Privacy & Compliance This position requires adherence to Tres Health’s security and privacy policies, including HIPAA compliance. All employees must complete security training and comply with access management protocols. Physical Requirements Prolonged periods of sitting and working at a computer. Ability to communicate effectively through video, phone, and written platforms. Ability to effectively use computers, video conferencing tools, and other standard remote work technology. Visual and auditory capabilities suitable for remote work. Ability to occasionally lift up to 15 pounds. Tres Health is committed to ADA compliance and will provide reasonable accommodations to individuals as needed. Employment Status This position is governed by at-will employment, meaning either the employee or Tres Health may end the employment relationship at any time, with or without cause or notice, as permitted by law. EEO & Reasonable Accommodation Tres Health is an Equal Opportunity Employer. Qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other protected category. Tres Health provides reasonable accommodations to enable individuals with disabilities to perform the essential functions of the role. This description is not intended to list all duties or qualifications and may be updated at any time. #J-18808-Ljbffr