Position OverviewThe Contact Center Escalation Specialist is responsible for investigating, documenting, and resolving complex member and provider complaints within Harbor Health's contact center.This role requires strong analytical skills, deep knowledge of health insurance processes, and a commitment to delivering thorough, compliant resolutions. The Escalation Specialist collaborates closely with Legal, QA, and Operations teams to address systemic issues and ensure outstanding member outcomes.Duties & ResponsibilitiesConduct research and analysis of incoming member and provider complaints to determine root causes and appropriate corrective actions Implement resolution strategies for complex member issues, ensuring consistent and compliant outcomes in line with Harbor Health policies and regulatory requirementsDocument all complaint details, investigation steps, resolutions, and follow-up activities with meticulous accuracy in the designated tracking systemEnsure complaint handling procedures and resolutions adhere to internal policies and applicable regulations (HIPAA, CMS, TDI)Execute timely, proactive follow-up with members and internal stakeholders to confirm resolution satisfaction and mitigate recurrence or further escalationCollaborate cross-functionally with Legal, Quality Assurance, and Operations to address systemic issues identified through the complaints processDesired Professional Skills & ExperienceRequired1–2 years of experience in member services or provider services within a healthcare environmentComprehensive understanding of health insurance plan processes: claims, appeals, grievances, and prior authorizations Proficiency in healthcare compliance standards and internal policies related to complaint management (HIPAA, CMS, TDI) Proven experience with compliance procedures and medical group plan operationsExceptional written and verbal communication; ability to manage sensitive member issues with professionalismStrong research, analysis, and problem-solving skills to identify root causes and implement effective resolutionsCompetency maintaining records in CRM or complaint management softwareAbility to collaborate effectively with Legal, QA, and Operations teamsPreferredPrior experience in a primary care or value-based care settingFamiliarity with payvider, ACO, or managed Medicaid/Medicare environmentsExperience with Athena or similar EHR/practice management systemsBilingual: English / Spanish Understanding of HEDIS or Star Ratings quality measuresWhat We OfferOpportunity to shape how Harbor Health resolves member issues and builds trust in a first-of-its-kind payvider model in TexasCollaborative and dynamic work environment where your effort and voice are visibleAn organization of people passionate about transforming healthcare for underserved communitiesCompetitive salary and benefits package Professional development and growth opportunities as the team scales A transparent startup culture with direct access to leadershipHarbor 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
