Supervisor, Escalation

Position Overview The 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 & Responsibilities Direct and supervise team research and analysis of all incoming member and provider complaints to determine root causes and appropriate corrective actions Develop, implement, and continuously refine resolution methodologies and SOPs for complex member issues, ensuring consistency and regulatory compliance Maintain integrity of the complaint tracking system; ensure all complaint details, investigation steps, resolutions, and follow-up activities are rigorously documented Ensure 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 recurrence Generate and formally present comprehensive reports on complaint trends, resolution cycle times, and compliance metrics to senior leadership Serve as primary cross-functional liaison with Legal, QA, and Operations to address systemic deficiencies identified through the complaints process Act as final escalation point for highly complex or sensitive issues; provide expert guidance throughout the resolution lifecycle Develop and oversee the contact center QA program, including call monitoring, transaction review, scoring calibration, and SOP maintenance Coach, develop, and performance-manage resolution team members; drive process improvement using Lean, Six Sigma, or similar methodologies Desired Professional Skills & Experience Required 3+ years in healthcare contact center operations with a focus on escalations, grievances, or appeals Thorough knowledge of health insurance operations: claims, enrollment/eligibility, billing, prior authorization, and provider networks Expert understanding of HIPAA, CMS, TDI, and state/federal managed care compliance standards Demonstrated experience with both member and provider services escalation processes Ability to interpret EOBs, plan policy language, and contractual agreements to resolve member disputes Strong team leadership, coaching, and performance management skills Exceptional written and verbal communication; able to manage executive-level and high-stakes member communications Proficiency in complaint tracking/CRM systems and reporting tools Bachelor's degree preferred; equivalent work experience considered Preferred Experience in a payvider, ACO, or value-based care environment Lean, Six Sigma, or process improvement methodology certification Familiarity with HEDIS, Star Ratings, and quality performance metrics Bilingual: English / Spanish Experience with Athena or similar EHR platforms Prior experience in a startup or high-growth healthcare organization

What We Offer

Opportunity to build and shape Harbor Health's member resolution function — defining standards in a payvider model that puts members first Collaborative, cross-functional environment where contact center, clinical, and plan operations work side by side An organization of people passionate about transforming healthcare for underserved communities in Texas Competitive salary and benefits package Professional development and growth opportunities as Harbor scales A transparent startup culture where your voice shapes how we operate Harbor 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 law. Apply To This Job