foodsmart - Member Support Specialist, Escalations & Accommodations
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Requirements
• Lead de-escalation efforts with empathy, professionalism, and control. • Balance compassion with boundary-setting to maintain productive interactions. • Ensure members feel supported, respected, and confident in the resolution process. • Judgment & Decision-Making • Make independent, high-stakes decisions within established guidelines. • Identify when to escalate issues further vs. resolve directly. • Recognize patterns and recommend improvements to reduce future escalations. • Advanced Critical Thinker: Ability to assess complex, ambiguous situations and determine the best course of action. • Agile in Communication: Strong written and verbal communication skills with the ability to tailor tone and messaging across audiences. • Sound Judgment: Trusted to make decisions on sensitive accommodation and escalation cases. • De-escalation & Mediation Minded: Proven ability to manage high-emotion interactions and drive resolution. • Empathetic with Authority: Can create a supportive experience while maintaining control and direction of the conversation. • Detail Orientated: Strong documentation and compliance mindset, especially with sensitive or regulated processes. • Ethical and Accountable: Possesses strong sense of personal and professional ethics and will take accountability for actions and decisions. • Reliable high speed internet access with minimum speeds of roughly 100 Mbps download and 20 Mbps upload. • A completely private, secure, and quiet workspace. • Bachelor’s degree or higher. • 3–5+ years in member/patient support, escalations, grievances, or case management. • Experience working with health plans, healthcare systems, or regulated environments preferred. • Demonstrated experience handling complex escalations or complaint resolution. • Familiarity with accessibility and accommodation processes (preferred). • Experience reviewing formal documentation (e.g., authorized representative forms, medical or legal documentation) is a plus.
Responsibilities
• Escalations & Grievance Management • Own and resolve high-priority, complex, or sensitive member escalations end-to-end. • Serve as the “last line” point of contact for unresolved member concerns • Investigate grievances thoroughly, synthesizing information from multiple systems and stakeholders. • Ensure timely, compliant, and well-documented resolution of all escalations. • Accessibility & Accommodation Requests • Review and assess accommodation and accessibility requests with sound judgment and consistency. • Evaluate supporting documentation, including authorized representative forms and related records. • Determine appropriate next steps, including approvals, denials, or escalations • Partner with internal teams to ensure accommodations are implemented and documented effectively. • Cross-Functional & External Communication • Communicate professionally and clearly with health plans, providers, and external partners. • Adapt communication style based on audience (members, executives, clinical and member support teams, partners). • Translate complex issues into actionable insights for internal stakeholders. • Complex escalations are resolved efficiently and thoughtfully. • Members feel heard and supported—even in difficult situations. • Health plan and partner communications are clear, professional, and effective. • Accommodation decisions are consistent, fair, and well-documented. • Trends in escalations are identified and fed back to improve the overall member experience.
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