Escalations Program Lead

GeoBlue has created a new department within the Operations team! This enterprise-wide support team will advance our capabilities in monitoring, analyzing and responding to customer feedback. The Customer Response Team is currently seeking the following positions: Customer Response Team Manager, Escalations Program Lead and 2 Escalation Specialists.

The Escalations Program Lead reports to the Customer Response Team Manager & is salary grade EA 47 with a minimum base salary of $90,868. Internal candidates can further discuss compensation details with the Talent Discovery partner.

The Escalations Program Lead plays a critical role in managing and resolving complex member issues, executive inquiries, and escalations with accuracy, timeliness, and adherence to organizational and regulatory standards. Key responsibilities include conducting in-depth case analysis, ensuring compliance with turnaround time requirements, and identifying trends to inform process improvements. This role requires a strong analytical mindset to review documentation, identify appropriate actions, and, when necessary, develop clear, well-reasoned responses for members, providers, regulators, or internal stakeholders. This role also involves direct outreach to impacted parties, both internal and external, to facilitate resolution and deliver a positive customer experience.

Responsibilities:

• Oversee the intake, triage, and resolution of complex or high-visibility escalations from members, providers, regulators, and internal stakeholders
• Collaborate with Operations, Clinical, Legal, Compliance, and Transformation teams to resolve escalations and identify root causes
• Be the customer voice, identifying trends and systemic issues that impact satisfaction and trust
• Drive process enhancements and preventive strategies to reduce future escalations and improve first-contact resolution
• Respond to escalations providing a clear and concise summary, root cause analysis and documentation outlining the overall issue and steps taken to resolve
• Communicate with internal leadership, client management and other key areas on status of escalations keeping all stakeholders updated on progress
• Collaborate with the Operations Leadership and the Learning & Development Team to identify and recommend individual and group opportunities for improvement based on escalation trends
• Monitor and maintain key performance metrics and collaborate on planning and execution of remedial plans to close any performance gaps
• Maintain proficiency in company products, services, programs. protocols, regulatory compliance and operations procedures
• Ensure compliance with HIPAA regulations, to include required confidentiality

• At least 5 years of equivalent healthcare operations experience. Experience in a service center or Operations is a plus
• Strong customer service ethos with a passion for improving customer experience and satisfaction
• Excellent listening, verbal, written, and telephone etiquette business communication skills
• Strong facilitation, investigative, analytical and problem-solving skills, as well as excellent organization and time management skills
• Strong collaboration skills to work across departments and with all levels to resolve inquiries
• Proficient with Microsoft Office products and Salesforce Health Cloud
• Solid understanding of telephony hardware and software applications is a plus