Senior Associate, Resolution Response Team

This is a fully remote position, open to applicants in Arizona, +24 more states.

📋 Description

• Manage escalated member cases from start to finish as the sole accountable individual for moderate-to-high complexity issues related to billing, reimbursement, benefits, coordination of benefits, network exceptions, and service breakdowns.

• Perform structured investigations utilizing the established triage framework, analyzing ticket history, call recordings, previous guidance, client documentation, spend, and reimbursement records.

• Drive service recovery by reviewing low-rated interactions, initiating proactive outreach, implementing de-escalation protocols, and ensuring resolution with a documented member recap.

• Act as the main cross-functional liaison across MBS, Support, Care Delivery, Client Success, Payment Operations, Network Operations, Product, Engineering, and Legal/Compliance.

• Engage with members using approved macros and empathetic, legally compliant language.

• Supply CSMs with clear case summaries and polished client-facing communications as required.

• Identify and route risks utilizing Critical/High/Standard severity and SEV 2/SEV 3 legal protocols.

• Maintain accurate records in Zendesk and the escalation tracker with detailed themes, reason codes, and ownership tags.

• Recognize escalation trends and spearhead improvements in macros, playbooks, and processes to minimize recurrence and avert repeat escalations.

⛳️ Requirements

• Bachelor’s degree in Healthcare Administration, Business, Communications, or a related field preferred, or equivalent experience.

• 3+ years in escalation management, member/customer advocacy, health benefits, or healthcare operations.

• Proven experience in resolving complex, multi-stakeholder escalations.

• Strong understanding of employer-sponsored benefits, reimbursement and claims workflows, and the fertility/family-building member journey.

• Familiarity with Zendesk, Jira, Guru, Google Sheets, and Looker.

• Excellent critical thinking, root-cause analysis, and structured case management abilities.

• Superior verbal and written communication skills with strong de-escalation capabilities.

• Ability to distill complex benefits and billing issues into clear resolution strategies.

• Sound legal and risk judgment.

• Capability to determine when to engage Legal, Compliance, or leadership.

• Proficient in managing high-emotion, high-stakes cases until resolution.

• Resourceful, solutions-focused, and adaptable to changing priorities.

• Active work authorization in the US.

🏝️ Benefits

• Equity.

• Employer-covered health insurance.

• Dental insurance.

• Options for insurance plans.

• Access to Maven’s virtual care platform and specialists, including mental health, reproductive health, family planning, and pediatrics.

• Wellness partnerships.

• Hybrid work arrangements.

• In-office meals.

• Team collaboration days.

• 16 weeks of 100% paid parental leave for employees with over 1 year of tenure.

• New parent stipend for employees with over 1 year of tenure.

• Annual professional development stipend.

• Personal career coach through Maven for Mavens.

• 401(k) matching for US-based employees with immediate vesting.