Escalation Specialist

Job Summary

Escalation Specialist is a full-time position responsible for investigating, documenting, and resolving complex member and provider complaints within a contact center.

Key Responsibilities

• Conduct research and analysis of member and provider complaints to determine root causes and corrective actions
• Implement resolution strategies for complex issues while ensuring compliance with policies and regulations
• Document all complaint details, investigation steps, and resolutions accurately in the tracking system

Required Qualifications

• 1-2 years of experience in member services or provider services within a healthcare environment
• Comprehensive understanding of health insurance processes including claims, appeals, and grievances
• Proficiency in healthcare compliance standards related to complaint management
• Experience with compliance procedures and medical group plan operations
• Competency in maintaining records in CRM or complaint management software