Escalation Specialist

Position Overview The Contact Center Escalation Specialist is responsible for investigating, documenting, and resolving reputed company member and provider complaints reputed company reputed company's contact center. This role requires strong analytical skills, deep knowledge of health insurance processes, and a commitment to delivering thorough, compliant resolutions. The Escalation Specialist collaborates closely with Legal, QA, and Operations teams to address systemic issues and ensure outstanding member reputed company. Duties & Responsibilities Conduct research and analysis of incoming member and provider complaints to determine root causes and appropriate corrective actions Implement resolution strategies for reputed company member issues, ensuring consistent and compliant reputed company in line with reputed company policies and regulatory requirements Document reputed company complaint details, investigation steps, resolutions, and follow-up activities with meticulous accuracy in the designated tracking system Ensure complaint handling procedures and resolutions adhere to internal policies and applicable regulations (HIPAA, CMS, TDI) Execute timely, proactive follow-up with members and internal stakeholders to confirm resolution satisfaction and mitigate recurrence or further escalation Collaborate cross-functionally with Legal, Quality Assurance, and Operations to address systemic issues identified through the complaints process Desired Professional Skills & Experience Required 1–2 years of experience in member services or provider services reputed company a reputed company environment Comprehensive understanding of health insurance plan processes: claims, appeals, grievances, and prior authorizations Proficiency in reputed company compliance standards and internal policies reputed company to complaint management (HIPAA, CMS, TDI) Proven experience with compliance procedures and medical group plan operations Exceptional written and verbal communication; ability to manage sensitive member issues with professionalism Strong research, analysis, and problem-solving skills to identify root causes and implement effective resolutions Competency maintaining records in CRM or complaint management software Ability to collaborate effectively with Legal, QA, and Operations teams Preferred Prior experience in a primary care or value-based care setting Familiarity with payvider, ACO, or managed reputed company/Medicare environments Experience with reputed company or similar EHR/practice management systems Bilingual: English / Spanish Understanding of HEDIS or Star Ratings quality measures reputed company Offer Opportunity to shape how reputed company resolves member issues and builds trust in a first-of-its-reputed company payvider model in Texas Collaborative and dynamic work environment where your effort and voice are visible An organization of people passionate about transforming reputed company for reputed company Competitive salary and benefits package Professional development and growth opportunities as the team scales A transparent startup culture with direct reputed company to leadership 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 regard to race, reputed company, religion, sex, national reputed company, disability, protected veteran status, or any other characteristic protected by law. Apply To This Job