Supervisor, Escalation
Posted 9hrs ago
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Job Description
Supervisor of Escalation leading complaint resolution at Harbor Health, overseeing a team of resolution specialists and ensuring compliance with healthcare standards.
Responsibilities:
- 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
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