Manager – Executive Escalations

🕒 vor 4 Tagen

🐻 Alaska, California, +11 weitere Bundesländer – Remote

🐻 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 / Jahr

⏰ Vollzeit

🟡 Mittelstufe

🟠 Senior

👔 Manager

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GEHA Health

WebsiteLinkedInAlle Stellen

1001 - 5000 Mitarbeiter

Gegründet 1937

⚕️ Krankenversicherung

🧘 Wellness

🏛️ Regierung

Healthcare Insurance • Wellness • Government

GEHA Health ist eine große Leistungsgesellschaft, die sich der Betreuung von Bundesangestellten, Rentnern und ihren Familien widmet. Gegründet 1937 von Postarbeitern, bietet GEHA eine umfassende Palette von Gesundheits- und Zahnplänen, einschließlich FEHB- und PSHB-Optionen, sowie zusätzliche Leistungen wie Fitnessstudio-Mitgliedschaften, Sehhilfen und Wellness-Prämien. Mit einem Netzwerk von 1,7 Millionen Anbietern landesweit und umfangreicher Abdeckung von verschreibungspflichtigen Medikamenten, legt GEHA Wert auf die Reinvestition von Gewinnen zur Verbesserung der Mitgliedererfahrung und zur Unterstützung der Gesundheit der Bundesbelegschaft. Ihre Pläne umfassen Medicare Advantage-Optionen und ein robustes Telemedizin-Angebot, um sicherzustellen, dass ihre Mitglieder die bestmögliche Pflege und Abdeckung erhalten.

Beschreibung

• 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.

🎯 Anforderungen

• 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.

🏖️ Vorteile

• 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