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Provider Service Representative  


PeakTPA provides services that optimize your organization's financial management and fulfill regulatory requirements for health plan functions. Our expertise in health plan management, particularly in PACE, means you can focus on delivering high-quality care to your participants.

Under the supervision of the Client Service Manager and Provider Service Supervisor, the Provider Service Representative is responsible for answering calls from our clients' medical provider network 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.

May be on-site or remote if internet requirements, and other specific requirements, are met.

Essential Functions:

  • Responds to provider 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 with providers 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

Additional Functions:

  • 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 position

Position Requirements

Knowledge, 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.
  • Call center experience highly 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
  • Occasional bending/stooping

Work Environment:

  • This job operates in a professional 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
Full-Time/Part-Time Full-Time  
Shift Days  
Position Provider Service Representative  
Post Internal Days 0  
Number of Openings 1  
Location Peak Health Plan Management- St Louis, MO  
About the Organization  
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.  
Cell None Specified 

HoursPerWk None Specified 

supervisorUID None Specified 

This position is currently not accepting applications.

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