Supervisor, Escalation

🔥 8 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Harbor Health

WebsiteLinkedInAll Job Openings

11 - 50 employees

⚕️ Healthcare Insurance

Healthcare Insurance

Harbor Health is a healthcare provider offering a range of medical services, including Express Care for immediate medical needs like sore throats, seasonal allergies, and annual wellness visits. They emphasize a co-creation approach to health, working collaboratively with patients to achieve optimal health outcomes. Harbor Health provides virtual and traditional appointment options and accepts most insurance plans, ensuring accessible healthcare for their clients. With multiple clinics, including specialized Express Care locations, they focus on offering warm, welcoming, and efficient care, as evidenced by positive patient reviews.

📋 Description

• Lead the complaint resolution function, overseeing a team of resolution specialists • Ensure resolution processes are consistent, compliant with HIPAA, CMS, TDI, and internal policy standards, and continuously improving • Serve as the primary cross-functional liaison between the contact center, Legal, Compliance, Quality Assurance, and Operations • Act as the final escalation point for the most complex and sensitive member issues • Direct and supervise team research and analysis of all incoming member and provider complaints to determine root causes and appropriate corrective actions • Develop, implement, and continuously refine resolution methodologies and SOPs for complex member issues • Maintain integrity of the complaint tracking system; ensure all complaint details, investigation steps, resolutions, and follow-up activities are documented • Ensure all complaint-handling procedures adhere to internal policies and applicable regulations • Design and manage proactive member and stakeholder follow-up processes to confirm resolution satisfaction and mitigate issue recurrence • Generate and formally present comprehensive reports on complaint trends, resolution cycle times, and compliance metrics to senior leadership • Develop and oversee the contact center QA program, including call monitoring, transaction review, scoring calibration, and SOP maintenance • Coach, develop, and performance-manage resolution team members; drive process improvement using Lean, Six Sigma, or similar methodologies

🎯 Requirements

• 3+ years in healthcare contact center operations with a focus on escalations, grievances, or appeals • 3+ years in a leadership role with direct reports • Thorough knowledge of health insurance operations: claims, enrollment/eligibility, billing, prior authorization, and provider networks • Expert understanding of HIPAA, CMS, TDI, and state/federal managed care compliance standards • Demonstrated experience with both member and provider services escalation processes • Ability to interpret EOBs, plan policy language, and contractual agreements to resolve member disputes • Strong team leadership, coaching, and performance management skills • Exceptional written and verbal communication skills; able to manage executive-level and high-stakes member communications • Proficiency in complaint tracking/CRM systems and reporting tools • Bachelor's degree preferred; equivalent work experience considered • Experience in a payvider, ACO, or value-based care environment preferred • Lean, Six Sigma, or process improvement methodology certification preferred • Familiarity with HEDIS, Star Ratings, and quality performance metrics preferred • Bilingual in English/Spanish preferred • Experience with Athena or similar EHR platforms preferred • Prior experience in a startup or high-growth healthcare organization preferred.

🏖️ Benefits

• Competitive salary and incentives • Generous PTO • 10 paid holidays • Medical, Dental, and Vision Insurance • 401(k) Investment Plan • Company Equity • Professional development and growth opportunities as Harbor Health scales