Customer Service Team Lead

About Tres Health
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.

Essential Duties & 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.