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About the Role

The Member Experience Escalation Advocate/Team Lead resolves complex service escalation issues for TX HB members and internal stakeholders. This role involves investigating issues, collaborating with third-party administrators, and providing training and mentorship on TX HB benefits administration. The position requires expertise in de-escalation, strong communication, and partnering skills to navigate stressful situations and vendor relationships effectively.

Responsibilities

Handles complex and escalated calls, including ancillary benefit inquiries.
Identifies and manages member and vendor issues, escalating to management as needed.
Builds relationships with internal staff and external vendors to resolve escalations.
Identifies process improvements and training gaps to enhance member and employee experience.
Serves as the primary point of contact for employees needing Member Experience team assistance.
Identifies trends and root causes in escalated calls to implement strategies for reduction.
Presents and leads in team huddles and training sessions.
Assists leadership in maintaining and updating departmental Policies and Procedures.
Supports Member Experience Manager in creating training and resource materials.
Partners with leadership in developing and conducting employee training.
May supervise the team and manage call queues in the manager’s absence.

Requirements

Expert knowledge of all TX HB administered benefits, policies, processes, rules, and regulations.
Excellent verbal and written communication skills, especially in diffusing difficult 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 trend identification.
Strong attention to detail and ability to prioritize workload.
Advanced knowledge of contact center software and tools.
Ability to coach and mentor staff.
Office location in a quiet, low-traffic area to minimize noise and disruptions.
A private, enclosed space with a door is preferred for member confidentiality and privacy compliance.
Ability to speak/hear clearly for phone and in-person communication.
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.

Skills

De-escalation
Communication (Verbal and Written)
Partnering and Rapport Building
Problem Solving
Critical Thinking
Time Management
Organization
Prioritization
Attention to Detail
Coaching
Mentoring

Location

Remote

Work Type

100% Remote
Full-time

Experience Level

Three or more years in a contact center environment
At least two years of experience in a health insurance/healthcare related contact center
One or more years of experience handling escalated calls

Education Level

Associate’s degree