Harbor Health
Supervisor, Escalation
Texas Markets | Contact Center Operations | Full-Time
POSITION OVERVIEW
Harbor Health is seeking a Supervisor of Escalation to lead our complaint resolution function, overseeing a team of resolution specialists responsible for investigating member and provider grievances, appeals, and escalated issues. In this role, you will ensure resolution processes are consistent, compliant with HIPAA, CMS, TDI, and internal policy standards, and continuously improving. You will serve as the primary cross-functional liaison between the contact center, Legal, Compliance, Quality Assurance, and Operations — and as the final escalation point for the most complex and sensitive member issues. This role is central to our mission of delivering a member-centered experience that transforms healthcare through our payvider model.
POSITION 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, including HIPAA, CMS, TDI, and 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
- 3+ years in a leadership role with direct reports
- 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 skills; 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 in English/Spanish
- Experience with Athena or similar EHR platforms
- Prior experience in a startup or high-growth healthcare organization
WHAT WE OFFER
- Competitive salary and incentives
- Generous PTO
- 10 paid holidays
- Medical, Dental, and Vision Insurance
- 401(k) Investment Plan
- Company Equity
- Professional development and growth opportunities as Harbor Health scales
At 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!
