Member Support Specialist – Escalations, Accommodations

📋 Description

• Take ownership and resolve high-priority, intricate, or sensitive member escalations from start to finish.

• Act as the final point of contact for unresolved member issues.

• Conduct thorough investigations into grievances by synthesizing information from various systems and stakeholders.

• Ensure that all escalations are resolved in a timely, compliant, and well-documented manner.

• Review and evaluate accommodation and accessibility requests with sound judgment and consistency.

• Assess supporting documentation, including forms from authorized representatives and associated records.

• Decide on appropriate next steps, which may include approvals, denials, or further escalations.

• Communicate in a professional and clear manner with health plans, providers, and external partners.

• Lead de-escalation efforts with empathy, professionalism, and control.

• Make independent, high-stakes decisions within established guidelines.

⛳️ Requirements

• A bachelor’s degree or higher.

• 3–5+ years of experience in member/patient support, escalations, grievances, or case management.

• Preferred experience working with health plans, healthcare systems, or in regulated environments.

• Proven experience in managing complex escalations or resolving complaints.

• Familiarity with accessibility and accommodation processes is preferred.

• Experience in reviewing formal documentation (e.g., authorized representative forms, medical or legal documentation) is an advantage.

🏝️ Benefits

• Remote-First Company

• Unlimited PTO

• Flexible & remote location

• Healthcare Coverage (Medical, Dental, Vision)

• 401k & bonus

• Registered Dietitian Sessions