Remote-Customer Success Lead

Job Duties/Responsibilities

• Escalation Ownership & Service Recovery Excellence
• Take full ownership of complex, urgent, and high-visibility member escalations, including executive and market leader cases, ensuring timely and complete resolution.
• Lead service recovery efforts with a focus on empathy, active listening, and restoring member trust through meaningful and caring interactions.
• Serve as the primary point of contact for sensitive or escalated issues, demonstrating accountability from intake through resolution.
• Ensure all escalation responses are accurate, compliant, and aligned with organizational tone and quality expectations.
• Partner cross-functionally to remove barriers and drive resolution for escalations that require coordination across departments.
• Operational Support Responsibilities
• Maintain a “working” role by handling inbound and outbound member interactions in alignment with departmental productivity and service level goals.
• Support daily triage and prioritization of escalation cases, ensuring appropriate assignment and timely follow-up.
• Monitor active cases to ensure adherence to SLAs, quality standards, and service recovery expectations.
• Address complaints and grievances in accordance with Medicare Managed Care requirements and internal procedures.
• Frontline Team Support & Enablement
• Serve as a subject matter expert and primary resource for Specialists, providing real-time guidance, coaching, and escalation support.
• Actively support frontline Specialists in navigating complex cases, reinforcing an ownership mindset and high standards of member care.
• Foster a culture of empathy and accountability across the team.
• Aid in onboarding, including nesting support, live call monitoring, and guidance to ensure readiness and confidence.
• Performance Monitoring & Continuous Improvement
• Assist in monitoring individual and team performance across productivity, quality, and service metrics.
• Identify trends in escalations and member feedback; provide insights and recommendations to leadership.
• Partner with Training and leadership to identify skill gaps and support ongoing development initiatives.
• Contribute to process improvement efforts aimed at reducing escalations, efficiencies and improving the overall member experience.
• Collaboration & Communication
• Collaborate closely with the Supervisor, Customer Success to ensure alignment of priorities, escalations, and team performance.
• Maintain clear, professional, and effective communication with internal stakeholders, including leadership and cross-functional partners.
• Support reporting needs related to escalation trends, risks, and service recovery outcomes.
• Compliance & Confidentiality
• Maintain strict adherence to HIPAA, privacy, and data security standards.
• Ensure all member interactions and case documentation meet regulatory and organizational compliance requirements.
• Other Responsibilities
• Assist with monitoring attendance and schedule adherence.
• Encourage a culture of accountability, collaboration, and continuous improvement.
• Perform other duties as assigned.
• Supports the Supervisor, Customer Success in the day-to-day oversight of team operations.
• Assists with planning and monitoring work; provides input on performance, as needed.
• Acts as a role model and leader within the team, particularly in handling escalations and supporting frontline staff.

Job Requirements

• Strong knowledge of Medicare Managed Care plans required
• 3+ years of customer service experience required (healthcare preferred)
• Previous Lead or equivalent experience required
• Preferred: Experience handling complex or executive-level escalations strongly preferred
• Bilingual (English/Spanish) preferred

Education

• High school diploma or GED with relevant work experience
• PREFERRED: Bachelor’s degree in Healthcare Administration, Business, or related field with relevant work experience

Training

• NONE

Specialized Skills

• Working knowledge of Microsoft Excel, PowerPoint, SharePoint, and Power BI
• Experience with Microsoft Teams and case management systems
• Strong communication skills with the ability to bridge people, process, and technology
• Demonstrated ability to handle high-pressure situations with professionalism and sound judgment
• Strong ownership mindset and accountability
• Empathy and emotional intelligence in high-stress interactions
• Conflict resolution and de-escalation expertise
• Critical thinking and problem-solving skills
• Ability to influence and support peers without direct authority

Preferred

• Bilingual (English/Spanish)

Licensure

• NONE