Manager – Executive Escalations

🕒 5 dias atrás

🐻 Alaska, California, +11 estados a mais – Remoto

🐻 Alaska – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🌺 Hawaii – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🗽 New York – Remote 🌲 Oregon – Remote 🔔 Pennsylvania – Remote 🍁 Vermont – Remote ☕ Washington – Remote 🦬 Wyoming – Remote

💵 $92.711 - $117.285 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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GEHA Health

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1937

⚕️ Seguro de Saúde

🧘 Bem-estar

🏛️ Governo

Healthcare Insurance • Wellness • Government

A GEHA Health é uma grande associação de benefícios dedicada a atender funcionários federais, aposentados e suas famílias. Fundada por trabalhadores dos correios em 1937, a GEHA oferece uma ampla gama de planos de saúde e odontológicos, incluindo opções FEHB e PSHB, além de benefícios adicionais, como assinaturas de academias, benefícios de visão e recompensas de bem-estar. Com uma rede de 1,7 milhão de prestadores de serviços em todo o país e ampla cobertura de medicamentos prescritos, a GEHA prioriza reinvestir os lucros para melhorar a experiência dos membros e apoiar a saúde da força de trabalho federal. Seus planos incluem opções de Medicare Advantage e uma oferta robusta de telemedicina, garantindo que seus membros recebam o melhor atendimento e cobertura possíveis.

Descrição

• Lead, coach, and develop a team of Executive Escalation Specialists responsible for end-to-end resolution of complex medical and dental escalations. • Establish clear performance expectations, conduct performance reviews, and provide ongoing feedback and development planning. • Ensure appropriate workload distribution, coverage, and escalation protocols to meet service level and quality expectations. • Foster a culture of professionalism, accountability, discretion, and strong member advocacy. • Provide oversight and guidance on the most sensitive, complex, or high-risk escalations, including OPM grievances, leadership-referred cases, and compliance concerns. • Serve as a management escalation point for cases requiring advanced judgment or executive-level communication. • Ensure consistent, accurate, and empathetic communication with members, providers, senior leaders, and external stakeholders. • Establish and maintain investigative standards for root cause analysis, including claims review, eligibility validation, audit of calls and correspondence, and process flows. • Ensure escalations are resolved accurately, compliantly, and with long-term systemic solutions in mind. • Apply sound judgment to balance member experience, regulatory requirements, contractual obligations, and reputational risk. • Partner closely with operations, pharmacy, dental, customer service, and vendors to resolve escalations and mitigate risk. • Lead or participate in cross-functional working sessions addressing systemic issues surfaced through executive escalations. • Oversee tracking, reporting, and analysis of executive-level escalations, trends, and outcomes. • Identify recurring issues and systemic breakdowns in the member journey. • Translate insights into actionable recommendations to improve processes, claims accuracy, and customer experience.

🎯 Requisitos

• Bachelor’s degree in a related field required. • 5-8 years of experience in a medical and/or dental health plan environment. • Minimum of 3 years of people management experience, preferably leading teams handling complex escalations or investigations. • Minimum of 2 years of demonstrated experience in implementing Lean management principles and executing process improvement initiatives. • Extensive knowledge of medical terminology, claims adjudication processes, and regulatory considerations. • Demonstrated ability to lead, coach, and develop high-performing teams. • Advanced analytical, investigative, and critical-thinking skills. • Exceptional written and verbal communication skills, including executive-level correspondence. • Strong judgment in managing sensitive situations and reputational risk. • Ability to summarize and present insights using Excel, PowerPoint, and/or Power BI.

🏖️ Benefícios

• Health/Vision/Dental benefits effective day one • 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution • Robust employee well-being program • Paid Time Off • Personal Community Enrichment Time • Company-provided Basic Life and AD&D • Company-provided Short-Term & Long-Term Disability • Tuition Assistance Program