You will:
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.
De-escalation & Member Experience
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.
You are:
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.
You have:
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.
Success in this role looks like:
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.
About our benefits and perks:
✅ Remote-First Company
✅ Unlimited PTO
✅ Flexible & remote location
✅ Healthcare Coverage (Medical, Dental, Vision)
✅ 401k & bonus
✅ Registered Dietitian Sessions
Foodsmart is an Equal Opportunity Employer. It is our firm policy to extend equal employment and advancement opportunity to all applicants and employees without regard to race, color, national origin, citizenship status, religious creed, age, sex (including pregnancy, childbirth, breastfeeding, medical conditions related to pregnancy, childbirth and/or breastfeeding), gender, gender identity and expression, sexual orientation, marital status, disability (physical or mental) and/or a medical condition, genetic information, ancestry, veteran status or service in the uniformed services, and any other characteristic protected by applicable federal, state or local law.
