Escalation Coordinator Senior - remote

    • Tampa, FL

Kforce has a client in search of an Escalation Coordinator Senior in Tampa, Florida (FL). This role is currently 100% remote and will switch back to office environment when COVID-19 ramps down. Summary: The candidate will research and resolve all escalations from members/providers that have been addressed to Executive Offices, Executive Leadership Team or the CEO (Presidential) as well as complaints coming from other escalated areas such as MET, Grievances, and other areas for final resolution. The Service Escalation Unit (SEU) team is the highest level of escalation and handles issues for all lines of business (Medicare, Medicaid, PDP & Exchange). Key Duties and Responsibilities:

  • Resolve the most highly escalated issues coming from other escalated areas such as MET, Grievances, and other areas for final resolution; The SEU team is the highest level of escalation
  • Take escalated inbound/outbound phone calls on behalf of our Executive Leadership Team for all lines of business while maintaining the highest standard of quality on every call; Logs, tracks, resolves and responds to all assigned inquiries and complaints from members, providers, governing bodies, Regulatory Agencies, Better Business Bureau, Social Media, legal Department, Corporate Compliance TRUST Department, Agency for Healthcare Administration (AHCA) and Florida Healthy Kids in writing and/or by telephone, while meeting all regulatory, AHCA and Corporate guidelines in which special care is required to enhance relationships; while meeting and exceeding all performance standards
  • Subject Matter Expert in all lines of business
  • Effectively handle/resolve highly escalated issues and represent our CEO in responding to these complaints in a professional manner seeking a win/win for all parties while respecting sound business and health management practices
  • Assist in the education of new members and in the re-education of existing members regarding health plan procedures

  • A High School diploma or GED Required
  • 3+ years of experience in a healthcare Contact Center or Customer Service environment handling escalated complaints involving one or more of the following Lines of Business: Medicare, Medicaid, PDP, Exchange, etc. Required
  • Demonstrated written communication skills Advanced
  • Demonstrated interpersonal/verbal communication skills Advanced
  • Ability to multitask Advanced
  • Demonstrated organizational skills Advanced
  • Demonstrated time management and priority setting skills Advanced
  • Ability to effectively present information and respond to questions from families, members, and providers Advanced
  • Demonstrated analytical skills Advanced
  • Ability to work with people from diverse backgrounds Advanced
  • Ability to act on feedback provided by showing ownership of their own development Advanced
  • Ability to define problems collects data, establish facts and draw valid conclusions Advanced
  • Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication Advanced
  • Microsoft Outlook Intermediate Required
  • Microsoft Word Intermediate Required
  • Microsoft Excel Intermediate Required
  • Microsoft PowerPoint Intermediate Preferred
  • SharePoint Intermediate Preferred
Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.

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