Member Experience Escalation Advocate/Team Lead

About the role

The Member Experience Escalation Advocate 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 collaborating with third-party administrators (TPA) or other benefit service providers to resolve issues promptly. The advocate assists with staff training and mentoring as a subject-matter expert on TX HB benefits administration, including processes, rules, and regulations. The position requires minimal supervision and allows considerable latitude for initiative and independent judgment.

This role demands expertise in de-escalating irate members, navigating stressful situations, and maintaining excellent verbal and written communication. Strong partnering and rapport-building skills are essential for effective collaboration with other departments and vendors.

Responsibilities

• Effectively handle complex calls, escalated calls, and advanced interactions, including ancillary benefit inquiries.
• Identify and proactively manage member and vendor issues, notifying management as needed.
• Partner and build relationships with internal staff and external vendors to resolve member escalations and vendor issues.
• Identify process improvements, training gaps, and actions to enhance the member and employee experience.
• Serve as the primary point of contact for TXHB employees requiring Member Experience team assistance.
• Identify patterns and root causes in escalated calls and work with leadership to implement strategies to reduce escalation volume.
• Present and lead team huddles and training sessions.
• Assist the leadership team in maintaining and updating departmental Policies and Procedures.
• Support the Member Experience Manager in creating training and resource materials.
• Partner 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 in diffusing irate situations.
• Strong knowledge of eligibility requirements, including Section 125 rules.
• Proficiency 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 in a health insurance/healthcare-related contact center.
• 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 substitute for one another.
• Preferred: Two years of experience working at TX HB.

Work Environment

This is a 100% remote role (Monday–Friday). The selected candidate must reside in Texas.

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 and 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.