Escalation Response Specialist II

Position Purpose: Assists with responding to complaints and escalations from members/providers. Supports in handling escalations, handling problem tickets, and providing feedback to senior team members regarding member/provider issues.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Preferred qualifications include healthcare or health plan experience as well as call center, phone based, and call escalation experience. Medicare experience is preferred.

Role requires candidates during peak months (Sept to March) to be able to work Saturdays and Sundays from 8:00 AM-4:30 PM their local time on a rotational schedule.

• Provides timely and appropriate resolutions to escalated issues received from various communication channels.
• Serves as a liaison in maintaining relationships between departments to ensure timely and appropriate issue resolution.
• Supports the documentation, tracking, and resolution to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner.
• Supports root cause analysis of member/provider issues to identify trends across the enterprise, and works cross functionally with all departments to ensure enterprise-wide solutions.
• Helps to coordinate with contact center team to research underlying facts of escalated inquiries, determine validity of complaints and evaluate options to remedy these complaints.
• Reviews complaint trends and uses guidance of senior team members to develop draft recommendations that are designed to enhance member and provider experience and reduce complaints and escalations.
• Maintains basic, introductory knowledge of our products and services to provide accurate and effective support to customers.
• In some instances, researches and identifies basic claims payment errors and make appropriate adjustments.
• Performs other duties as assigned.
• Complies with all policies and standards.