Member Experience Escalation Adv./Team Lead

About the role

The Member Experience Escalation Advocate/Team Lead is a key member of the Member Experience team, responsible for resolving highly complex service escalation issues from TX HB members, Benefit Coordinators, Member Service Advocates, Marketing staff, and other internal TX HB stakeholders. This role involves investigating service issues and working with the third-party administrator (TPA) or other benefit service providers to resolve issues in a timely manner. Assists with staff training and mentoring as a subject matter expert related to TX HB benefits administration, including processes, rules, and regulations. Works under limited supervision, with considerable latitude for the use of initiative and independent judgment.

This role requires a high level of expertise in de-escalating irate members and navigating stressful situations, along with excellent communication skills both verbally and in writing. Strong partnering and rapport-building skills are essential to work effectively with other departments and vendors.

Responsibilities

• Effectively handles complex calls, escalated calls, and advanced interactions, including ancillary benefit inquiries.
• Identifies and proactively manages member and vendor issues, notifying management as needed.
• Partners and builds relationships with internal staff and external vendors to resolve member escalations and vendor issues.
• Identifies process improvements, training gaps, and actions around improving the member and employee experience.
• Serves as the primary point of contact for TXHB employees that require Member Experience team assistance.
• Identifies patterns and root causes in escalated calls and works with leadership to implement strategies to reduce the volume of escalated calls.
• Presents and leads in team huddles and training sessions.
• Assists leadership team in maintaining and updating departmental Policies and Procedures.
• Supports Member Experience Manager in creating training materials and resource materials.
• Partners with leadership in developing and conducting contractor and employee training.
• May supervise the team and manage call queues in the manager’s absence.

Requirements

• Expert knowledge of all TX HB administered benefits, including policies, processes, rules, and regulations.
• Excellent verbal and written communication skills, particularly with respect to diffusing irate situations.
• Strong knowledge of eligibility requirements including Section 125 rules.
• Proficient in MS Office including PowerPoint and Excel.
• Strong time management, organization, and prioritization skills.
• Ability to work effectively in a shifting environment.
• Advanced problem-solving and critical thinking skills, including the ability to identify trends in data.
• Strong attention to detail and ability to prioritize and organize workload.
• Advanced knowledge of contact center software and tools.
• Ability to coach and mentor staff.

Qualifications

• Required: Associate’s degree.
• Three or more years in a contact center environment, including at least two years of experience in a health insurance/healthcare-related contact center.
• One or more years of experience handling escalated calls.
• Preferred: Graduation from an accredited four-year college or university with major coursework in business administration, insurance, or a related field. Experience and education may be substituted for one another.
• Two years of experience working at TX HB.

Work Environment

This is a 100% remote role. The office location should be in a quiet, low-traffic area to minimize noise and disruptions. A private, enclosed space with a door is preferred to support member confidentiality and ensure compliance with privacy standards.

Physical Demands

• Ability to speak/hear clearly to communicate by phone or in person.
• Ability to frequently stand, sit, and walk.
• Ability to frequently lift and/or move up to 15 pounds.
• Prolonged periods of sitting at a desk and working on a computer.

Schedule

8:00 AM - 5:00 PM (Monday - Friday). May be asked to work non-standard hours during peak times.