Position OverviewThe Supervisor of Escalation leads Harbor Health's complaint resolution function, overseeing a team of resolution specialists responsible for investigating member and provider grievances, appeals, and escalated issues.This role ensures resolution processes are consistent, compliant with HIPAA, CMS, TDI, and internal policy standards, and continuously improving. The Supervisor serves as the primary cross-functional liaison between the contact center, Legal, Compliance, Quality Assurance, and Operations.Duties & ResponsibilitiesDirect and supervise team research and analysis of all incoming member and provider complaints to determine root causes and appropriate corrective actionsDevelop, implement, and continuously refine resolution methodologies and SOPs for complex member issues, ensuring consistency and regulatory complianceMaintain integrity of the complaint tracking system; ensure all complaint details, investigation steps, resolutions, and follow-up activities are rigorously documentedEnsure all complaint-handling procedures adhere to internal policies and applicable regulations (HIPAA, CMS, TDI, Medicare/Medicaid/Commercial plan standards)Design and manage proactive member and stakeholder follow-up processes to confirm resolution satisfaction and mitigate issue recurrenceGenerate and formally present comprehensive reports on complaint trends, resolution cycle times, and compliance metrics to senior leadershipServe as primary cross-functional liaison with Legal, QA, and Operations to address systemic deficiencies identified through the complaints processAct as final escalation point for highly complex or sensitive issues; provide expert guidance throughout the resolution lifecycleDevelop and oversee the contact center QA program, including call monitoring, transaction review, scoring calibration, and SOP maintenanceCoach, develop, and performance-manage resolution team members; drive process improvement using Lean, Six Sigma, or similar methodologiesDesired Professional Skills & ExperienceRequired3+ years in healthcare contact center operations with a focus on escalations, grievances, or appeals3+ years in leadership role with direct reportsThorough knowledge of health insurance operations: claims, enrollment/eligibility, billing, prior authorization, and provider networksExpert understanding of HIPAA, CMS, TDI, and state/federal managed care compliance standardsDemonstrated experience with both member and provider services escalation processesAbility to interpret EOBs, plan policy language, and contractual agreements to resolve member disputesStrong team leadership, coaching, and performance management skillsExceptional written and verbal communication; able to manage executive-level and high-stakes member communicationsProficiency in complaint tracking/CRM systems and reporting toolsBachelor's degree preferred; equivalent work experience consideredPreferredExperience in a payvider, ACO, or value-based care environmentLean, Six Sigma, or process improvement methodology certificationFamiliarity with HEDIS, Star Ratings, and quality performance metricsBilingual: English / SpanishExperience with Athena or similar EHR platformsPrior experience in a startup or high-growth healthcare organizationWhat We OfferOpportunity to build and shape Harbor Health's member resolution function — defining standards in a payvider model that puts members firstCollaborative, cross-functional environment where contact center, clinical, and plan operations work side by sideAn organization of people passionate about transforming healthcare for underserved communities in TexasCompetitive salary and benefits packageProfessional development and growth opportunities as Harbor scalesA transparent startup culture where your voice shapes how we operateHarbor Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, or any other characteristic protected by
