Manager – Executive Escalations

🕒 il y a 8 jours

🐻 Alaska, California, +11 états de plus – Distant

🐻 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 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

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GEHA Health

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 1937

⚕️ Assurance santé

🧘 Bien-être

🏛️ Gouvernement

Healthcare Insurance • Wellness • Government

GEHA Health est une grande association de prestations dédiée à servir les employés fédéraux, les retraités et leurs familles. Fondée par des employés des postes en 1937, GEHA propose une gamme complète de plans de santé et dentaires, incluant des options FEHB et PSHB, ainsi que des avantages supplémentaires tels que des abonnements à des salles de sport, des avantages visuels et des récompenses bien-être. Avec un réseau de 1,7 million de prestataires à l'échelle nationale et une couverture étendue des médicaments sur ordonnance, GEHA privilégie la réinvestissement des bénéfices pour améliorer l'expérience des membres et soutenir la santé de la main-d’œuvre fédérale. Leurs plans comprennent des options Medicare Advantage et une offre robuste de télésanté, garantissant à leurs membres le meilleur soin et couverture possible.

Description

• 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.

🎯 Exigences

• 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.

🏖️ Avantages

• 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