Member Support Specialist, Escalations & Accommodations

• Own and resolve high-priority, complex, or sensitive member escalations end-to-end.
• Serve as the 'last line' point of contact for unresolved member concerns.
• Investigate grievances thoroughly, synthesizing information from multiple systems and stakeholders.
• Ensure timely, compliant, and well-documented resolution of all escalations.
• Review and assess accommodation and accessibility requests with sound judgment and consistency.
• Evaluate supporting documentation, including authorized representative forms and related records.
• Determine appropriate next steps, including approvals, denials, or escalations.
• Partner with internal teams to ensure accommodations are implemented and documented effectively.
• Communicate professionally and clearly with health plans, providers, and external partners.
• Adapt communication style based on audience (members, executives, clinical and member support teams, partners).
• Translate complex issues into actionable insights for internal stakeholders.
• Lead de-escalation efforts with empathy, professionalism, and control.
• Balance compassion with boundary-setting to maintain productive interactions.
• Ensure members feel supported, respected, and confident in the resolution process.
• Make independent, high-stakes decisions within established guidelines.
• Identify when to escalate issues further vs. resolve directly.
• Recognize patterns and recommend improvements to reduce future escalations.

• Advanced Critical Thinker with ability to assess complex, ambiguous situations and determine the best course of action.
• Strong written and verbal communication skills with the ability to tailor tone and messaging across audiences.
• Sound judgment with ability to make decisions on sensitive accommodation and escalation cases.
• Proven ability to manage high-emotion interactions and drive resolution.
• Can create a supportive experience while maintaining control and direction of the conversation.
• Strong documentation and compliance mindset, especially with sensitive or regulated processes.
• Possesses strong sense of personal and professional ethics and will take accountability for actions and decisions.
• Reliable high speed internet access with minimum speeds of roughly 100 Mbps download and 20 Mbps upload.
• Completely private, secure, and quiet workspace.
• Bachelor’s degree or higher.
• 3–5+ years in member/patient support, escalations, grievances, or case management.
• Experience working with health plans, healthcare systems, or regulated environments preferred.
• Demonstrated experience handling complex escalations or complaint resolution.
• Familiarity with accessibility and accommodation processes preferred.
• Experience reviewing formal documentation (e.g., authorized representative forms, medical or legal documentation) is a plus.

Pay range: $60K - $75K

• Remote-First Company
• Unlimited PTO
• Flexible & remote location
• Healthcare Coverage (Medical, Dental, Vision)
• 401k & bonus
• Registered Dietitian Sessions