Manager – Executive Escalations

This is a fully remote position, open to applicants in Alaska, +12 more states.

📋 Description

• Lead, mentor, and develop a team of Executive Escalation Specialists tasked with the comprehensive resolution of intricate medical and dental escalations.

• Set clear performance standards, conduct performance evaluations, and offer continuous feedback and development planning.

• Ensure suitable workload distribution, coverage, and escalation protocols to achieve service level and quality benchmarks.

• Cultivate a culture of professionalism, accountability, discretion, and robust member advocacy.

• Provide oversight and direction on the most sensitive, complex, or high-risk escalations, including OPM grievances, leadership-referred cases, and compliance matters.

• Act as a management escalation point for cases that require advanced judgment or executive-level communication.

• Guarantee consistent, accurate, and empathetic communication with members, providers, senior leaders, and external stakeholders.

• Develop and uphold investigative standards for root cause analysis, which includes claims review, eligibility validation, call and correspondence audits, and process flows.

• Ensure escalations are resolved correctly, compliantly, and with a focus on long-term systemic solutions.

• Exercise sound judgment to balance member experience, regulatory requirements, contractual obligations, and reputational risk.

• Collaborate closely with operations, pharmacy, dental, customer service, and vendors to resolve escalations and reduce risk.

• Lead or engage in cross-functional working sessions that address systemic issues identified through executive escalations.

• Oversee the tracking, reporting, and analysis of executive-level escalations, trends, and outcomes.

• Identify recurring issues and systemic failures in the member journey.

• Convert insights into actionable recommendations to enhance processes, claims accuracy, and customer experience.

⛳️ Requirements

• Bachelor’s degree in a relevant field is required.

• 5-8 years of experience within a medical and/or dental health plan environment.

• At least 3 years of experience in people management, ideally leading teams that handle complex escalations or investigations.

• Minimum of 2 years of proven experience in applying Lean management principles and executing process improvement initiatives.

• Extensive understanding of medical terminology, claims adjudication processes, and regulatory considerations.

• Proven ability to lead, mentor, and develop high-performing teams.

• Advanced analytical, investigative, and critical-thinking abilities.

• Outstanding written and verbal communication skills, including proficiency in executive-level correspondence.

• Strong judgment in handling sensitive situations and reputational risks.

• Capability to summarize and present insights using Excel, PowerPoint, and/or Power BI.

🏝️ Benefits

• Health/Vision/Dental benefits available from day one.

• 401(k) retirement plan with company match – dollar for dollar up to 4% of employee contribution (available in pretax or Roth options) plus a 6% annual company contribution.

• Comprehensive employee well-being program.

• Paid Time Off.

• Personal Community Enrichment Time.

• Company-provided Basic Life and AD&D insurance.

• Company-provided Short-Term & Long-Term Disability insurance.

• Tuition Assistance Program.