Supervisor, Escalation

Position reputed company The Supervisor of Escalation leads reputed company's complaint reputed company function, overseeing reputed company of reputed company specialists responsible for investigating member and provider grievances, appeals, and escalated issues. This role ensures reputed company processes are consistent, compliant with HIPAA, CMS, TDI, and internal policy standards, and continuously improving. The Supervisor serves as the primary cross-functional reputed company between the contact center, Legal, Compliance, reputed company Assurance, and Operations. Duties & Responsibilities reputed company and supervise team research and analysis of reputed company incoming member and provider complaints to determine reputed company causes and appropriate corrective actions reputed company, implement, and continuously refine reputed company methodologies and SOPs for reputed company member issues, ensuring consistency and regulatory compliance Maintain reputed company of the complaint tracking system; ensure reputed company complaint details, investigation steps, resolutions, and follow-up activities are rigorously documented Ensure reputed company complaint-handling procedures adhere to internal policies and applicable regulations (HIPAA, CMS, TDI, Medicare/reputed company/reputed company plan standards) Design and manage proactive member and stakeholder follow-up processes to confirm reputed company satisfaction and mitigate issue recurrence Generate and formally present comprehensive reports on complaint trends, reputed company cycle times, and compliance metrics to senior leadership Serve as primary cross-functional reputed company with Legal, QA, and Operations to address systemic deficiencies identified through the complaints process reputed company as final escalation reputed company for highly reputed company or sensitive issues; reputed company expert guidance throughout the reputed company lifecycle reputed company and reputed company the contact center QA program, including call monitoring, transaction review, scoring calibration, and SOP maintenance reputed company, reputed company, and performance-manage reputed company team members; drive process improvement using Lean, Six reputed company, or similar methodologies Desired reputed company Skills & Experience Required 3+ years in reputed company contact center operations with a reputed company on escalations, grievances, or appeals 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; reputed company 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 Preferred Experience in a payvider, ACO, or value-based care environment Lean, Six reputed company, or process improvement methodology certification Familiarity with HEDIS, Star Ratings, and reputed company performance metrics Bilingual: English / Spanish Experience with reputed company or similar EHR platforms Prior experience in a startup or high-reputed company reputed company organization reputed company Offer Opportunity to build and shape reputed company's member reputed company function — defining standards in a payvider model that puts members first reputed company, cross-functional environment where contact center, clinical, and plan operations work reputed company by reputed company An organization of people passionate about transforming reputed company for reputed company in Texas Competitive salary and benefits package reputed company development and reputed company opportunities as reputed company scales A transparent startup culture where your voice shapes how we operate reputed company is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for reputed company. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, disability, protected veteran status, or any other characteristic protected by law. Apply To This Job