Escalation Response Specialist II

Role overview

Help resolve complaints and escalated issues raised by health plan members and providers. You’ll investigate concerns, coordinate with internal teams, and support improvements to service by identifying recurring issues and sharing recommendations with senior colleagues.

Responsibilities

- Respond to escalated issues from multiple channels and document, track, and resolve complaints professionally and promptly. - Coordinate with contact center staff and other departments to research cases, assess complaint validity, and identify appropriate remedies. - Help analyze root causes and complaint trends, then contribute recommendations to improve the member and provider experience. - Maintain working knowledge of products and services to give accurate support; research basic claims payment errors and make adjustments when needed. - Keep senior team members informed about issues and resolution progress.

Requirements

- High school diploma or GED, with 1–2 years of related experience; vocational or technical education may also be required. - Ability to handle customer issues in writing and by phone with professionalism and care. - Must be authorized to work in the United States without current or future employment visa sponsorship.

Nice to have

- Experience in healthcare, health plans, call centers, phone support, or escalations; Medicare experience is also preferred.

Benefits and work setup

- During peak months, September through March, the role includes rotational weekend shifts on Saturdays and Sundays, 8:00 a.m.–4:30 p.m. local time. - Benefits may include health coverage, retirement and stock purchase plans, tuition assistance, paid time off, and holidays. Work arrangements may be remote, hybrid, field-based, or office-based.