Member Support Specialist, Escalations & Accommodations

Responsibilities:

• Own and resolve high-priority, complex, or sensitive member escalations and grievances from end to end.
• Review accommodation and accessibility requests, evaluating supporting documentation to make consistent, fair decisions.
• Ensure all escalations are resolved in a timely, compliant, and well-documented manner, implementing accommodations effectively.

Communication & Collaboration:

• Communicate professionally and clearly with health plans, providers, and external partners, adapting style based on the audience.
• Translate complex issues into actionable insights for internal stakeholders, including clinical and member support teams.
• Collaborate cross-functionally to investigate grievances thoroughly, synthesizing information from multiple systems and stakeholders.

Member Experience & Decision-Making:

• Lead de-escalation efforts with empathy, professionalism, and control to ensure members feel heard, supported, and respected.
• Make independent, high-stakes decisions within established guidelines, balancing compassion with necessary boundary-setting.
• Identify patterns in escalations to recommend process improvements that enhance the overall member experience and reduce future issues.