Harbor Health logo
Harbor Health

Welcome to Harbor Health, an entirely new multi-specialty clinic group in Austin, TX.

Supervisor, Escalation

Location

Texas

Posted

1 day ago

Salary

0

Seniority

Senior

Bachelor Degree3 yrs expEnglish

Job Description

Supervisor, Escalation

Harbor Health

• Lead the complaint resolution function, overseeing a team of resolution specialists • Ensure resolution processes are consistent, compliant with HIPAA, CMS, TDI, and internal policy standards, and continuously improving • Serve as the primary cross-functional liaison between the contact center, Legal, Compliance, Quality Assurance, and Operations • Act as the final escalation point for the most complex and sensitive member issues • Direct and supervise team research and analysis of all incoming member and provider complaints to determine root causes and appropriate corrective actions • Develop, implement, and continuously refine resolution methodologies and SOPs for complex member issues • Maintain integrity of the complaint tracking system; ensure all complaint details, investigation steps, resolutions, and follow-up activities are documented • Ensure all complaint-handling procedures adhere to internal policies and applicable regulations • Design and manage proactive member and stakeholder follow-up processes to confirm resolution satisfaction and mitigate issue recurrence • Generate and formally present comprehensive reports on complaint trends, resolution cycle times, and compliance metrics to senior leadership • Develop and oversee the contact center QA program, including call monitoring, transaction review, scoring calibration, and SOP maintenance • Coach, develop, and performance-manage resolution team members; drive process improvement using Lean, Six Sigma, or similar methodologies

Job Requirements

  • 3+ years in healthcare contact center operations with a focus on escalations, grievances, or appeals
  • 3+ years in a leadership role with direct reports
  • Thorough knowledge of health insurance operations: claims, enrollment/eligibility, billing, prior authorization, and provider networks
  • Expert understanding of HIPAA, CMS, TDI, and state/federal managed care compliance standards
  • Demonstrated experience with both member and provider services escalation processes
  • Ability to interpret EOBs, plan policy language, and contractual agreements to resolve member disputes
  • Strong team leadership, coaching, and performance management skills
  • Exceptional written and verbal communication skills; able to manage executive-level and high-stakes member communications
  • Proficiency in complaint tracking/CRM systems and reporting tools
  • Bachelor's degree preferred; equivalent work experience considered
  • Experience in a payvider, ACO, or value-based care environment preferred
  • Lean, Six Sigma, or process improvement methodology certification preferred
  • Familiarity with HEDIS, Star Ratings, and quality performance metrics preferred
  • Bilingual in English/Spanish preferred
  • Experience with Athena or similar EHR platforms preferred
  • Prior experience in a startup or high-growth healthcare organization preferred.

Benefits

  • Competitive salary and incentives
  • Generous PTO
  • 10 paid holidays
  • Medical, Dental, and Vision Insurance
  • 401(k) Investment Plan
  • Company Equity
  • Professional development and growth opportunities as Harbor Health scales

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