Executive Escalations Specialist

Advantage Tech

Lee's Summit, MO

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JOB DETAILS

SKILLS

Adjudication, Analysis Skills, Broadband, Business Intelligence Software, Claims Processing, Communication Skills, Continuous Improvement, Cross-Functional, Customer Experience, Customer Support/Service, DSL (Digital Subscriber Line), Dental Insurance, Documentation, HIPAA (Health Insurance Portability and Accountability Act), Health Plan, Identify Issues, Internet/Online Service, Leadership, Legal, Mail Processing, Medical Terminology, Microsoft Excel, Microsoft PowerPoint, Modems, Organizational Development/Management, Presentation/Verbal Skills, Problem Solving Skills, Process Improvement, Product Strategy, Quality Assurance, Quality Management, Quality Metrics, Regulations, Regulatory Compliance, Regulatory Requirements, Risk, Risk Management, Root Cause Analysis, Structured Analysis, Time Management, Trend Analysis, Writing Skills

LOCATION

Lee's Summit, MO

POSTED

19 days ago

ATI is looking for Sr Executive Escalations Specialist for our remote client.
Job Summary

The Sr. Executive Escalations Specialist reports to the Manager, Executive Escalations and serves as a senior individual contributor responsible for the end-to-end resolution of our most complex, sensitive, and high-risk medical and dental escalations.

This role functions as an expert-level investigator and trusted escalation owner, handling cases that carry heightened regulatory, reputational, financial, and/or executive visibility, including OPM grievances and leadership-referred matters. The Sr. Executive Escalations Specialist operates with substantial independence, applying advanced judgment, investigative rigor, and executive-level communication skills while representing us with professionalism and discretion.

This position is a part of the broader Product Intelligence & Strategy team. In addition to supporting the Manager, Executive Escalations in strengthening escalation practices, quality standards, and risk mitigation efforts, this role contributes to organizational insights and continuous improvement by identifying systemic issues, surfacing trends, and influencing strategic decisions.

Duties and Responsibilities

Executive Escalation Management

· Own the end-to-end management of the organizations most complex medical and dental escalations, including high-profile member complaints, leadership escalations, and OPM grievances.

· Represent professionally and accurately in communications with members, providers, senior leaders, regulators, and external stakeholders.

· Manage cases with heightened sensitivity to reputational risk, compliance obligations, and public perception, escalating appropriately to leadership when risk thresholds are met.

· Ensure timely, accurate, and defensible resolution outcomes that balance member advocacy, plan integrity, and regulatory requirements.

Advanced Investigation & Root Cause Analysis

· Ensure that comprehensive investigative reviews are conducted across claims adjudication, eligibility, benefit interpretation, call recordings, written correspondence, and process workflows.

· Perform detailed examinations of complex medical and dental claims to identify processing errors, policy misapplication, or systemic breakdowns.

· Apply structured root cause analysis techniques to differentiate between individual defects and broader process or system issues.

· Develop clear, well-supported findings and resolution rationales suitable for executive review or regulatory response.

Cross-Functional Collaboration

· Partner closely with operations, customer service, clinical teams, compliance, legal, and vendors to drive resolution of complex escalations.

· Participate in cross-functional working sessions to resolve cases and address systemic issues surfaced through executive escalations.

· Serve as a subject matter resource for complex or precedent-setting escalation scenarios.

Executive-Level Communication & Reporting

· Draft high-quality written responses and summaries on behalf of the Executive Escalations function, ensuring clarity, professionalism, and accuracy.

· Provide concise case summaries, insights, and escalation updates to the Manager, Executive Escalations and other leadership stakeholders.

· Support escalation tracking, documentation, and reporting efforts to ensure transparency, accountability, and audit readiness.

Intelligence & Continuous Improvement

· Identify recurring trends, risks, and breakdown points across escalations handled.

· Provide input and recommendations to leadership on process improvements affecting claims accuracy, member experience, and escalation prevention.

· Support quality initiatives and evolving investigative standards established by the Manager, Executive Escalations.

Education & Experience Requirements

· Bachelors degree in a related field required; equivalent experience may be considered in lieu of formal education.

· Minimum of 7 years experience in a medical and/or dental health plan environment.

· Advanced experience in complex claims adjudication, including deep understanding of medical and/or dental benefits, policies, and regulatory considerations.

· Demonstrated experience handling high-risk, high-visibility member escalations requiring strong judgment and discretion.

· Experience working escalations involving executive leadership or regulatory entities strongly preferred.

Required Skills & Competencies

· Advanced analytical, investigative, and critical-thinking capabilities.

· Strong independent judgment and ability to manage ambiguity in high-pressure situations.

· Exceptional written and verbal communication skills, including executive-level correspondence.

· Demonstrated knowledge in Lean and process improvement methodologies.

· Deep understanding of claims adjudication processes, medical terminology, and benefit interpretation.

· High degree of professionalism, discretion, and accountability.

· Ability to summarize findings and insights using Excel, PowerPoint, and/or BI tools.

Preferred Qualifications

· Experience with the Federal Employees Health Benefits Program (FEHB) and/or Federal Employees Dental and Vision Insurance Program (FEDVIP).

· Prior exposure to grievances, appeals, compliance inquiries, or regulatory response processes.

· Experience supporting quality improvement or risk mitigation initiatives within escalation or claims environments.

Work-at-Home Requirements

· Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.

· A minimum standard speed for optimal performance of 30x5 (30 mbps download x 5 mbps upload) is required.

· Latency (ping) response time lower than 80 ms.

· Hotspots, satellite, and wireless internet services are NOT allowed for this role.

· A dedicated space lacking ongoing interruptions is required to protect member PHI / HIPAA information.
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About the Company

Advantage Tech

Advantage Technical is an engineering and information technology services company. We offer 50+ years of specialty experience and an enviable network of connections for employers and job seekers alike.

We have specialization and depth in a number of critical industries including medical device, communications, product manufacturing, pharmaceuticals, chemicals, energy, semiconductor, government and defense. We also understand the commonalities and the differences across every client we serve. We will deliver the technical support you need to compete and win in the 21st century.

Advantage Technical supports our clients both locally and virtually from our regional hub and branch network and has excellent coverage for you and your organization across all of the US and Canada. Wherever you are, we will provide the highly talented resources you need to meet your goals and strengthen your business.

COMPANY SIZE

500 to 999 employees

INDUSTRY

Engineering Services

WEBSITE

https://advantagetechnical.com/

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