Escalation Specialist

Skip to Main Content CareersLog inEscalation SpecialistShow All JobsApplyLocationRemote - United StatesJob CategoryEscalation, Contact CenterIndustryHealthcareEmployee TypeNon-Exempt - FTMinimum Experience3 YearsDescriptionHarbor HealthContact Center Escalation SpecialistTexas Markets  |  Contact Center Operations  |  Full-TimePOSITION OVERVIEWHarbor Health is seeking a Contact Center Escalation Specialist to investigate, document, and resolve complex member and provider complaints within our contact center. This role requires strong analytical skills, deep knowledge of health insurance processes, and a commitment to delivering thorough, compliant resolutions. You will collaborate closely with Legal, QA, and Operations teams to address systemic issues and ensure outstanding member outcomes — serving as a trusted advocate for members and a key driver of service quality that aligns with our mission of transforming healthcare through our payvider model.POSITION DUTIES & RESPONSIBILITIESConduct research and analysis of incoming member and provider complaints to determine root causes and appropriate corrective actionsImplement 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, including HIPAA, CMS, and TDIExecute 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 & EXPERIENCERequired:1–2 years of experience in member services or provider services within a healthcare environmentComprehensive understanding of health insurance plan processes: claims, appeals, grievances, and prior authorizationsProficiency in healthcare compliance standards and internal policies related to complaint management, including HIPAA, CMS, and TDIProven experience with compliance procedures and medical group plan operationsExceptional written and verbal communication skills; 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 teamsPreferred:Prior 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 in English/SpanishUnderstanding of HEDIS or Star Ratings quality measuresWHAT WE OFFERCompetitive salary and incentivesGenerous PTO10 paid holidaysMedical, Dental, and Vision Insurance401(k) Investment PlanCompany EquityProfessional development and growth opportunities as the team scalesAt Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you're ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!