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Resolution Response Specialist

Maven Clinic· Benefits Support Delivery
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Remote$82k - $96kfull-timePosted 1mo ago

About the role

Resolution Response Specialist at Maven Clinic focusing on end-to-end resolution of complex member escalations, cross-functional collaboration, and risk management within a remote, Monday–Friday role.

Responsibilities

  • Own escalated member cases end-to-end, serving as the single accountable owner for moderate-to-high complexity issues across billing, reimbursement, benefits, coordination of benefits, network exceptions, and service breakdowns.
  • Conduct structured investigations using the established triage framework (Category → Owner → Macro → Checklist → SLA → Escalation Path), reviewing ticket history, call recordings, prior guidance, client documentation, spend, and reimbursement records before resolution.
  • Lead service recovery by reviewing low-rated interactions, conducting proactive outreach (call-first where possible), applying de-escalation protocols, and confirming closed-loop resolution with a written member recap.
  • Serve as the primary cross-functional bridge across MBS, Support, Care Delivery, Client Success, Payment Operations, Network Operations, Product, Engineering, and Legal/Compliance to coordinate corrective action and accelerate resolution.
  • Communicate with members using approved macros and empathy-led, legally protective language; provide CSMs with concise case summaries and polished client-facing messaging when needed.
  • Identify and route risk using Critical/High/Standard severity and SEV 2/SEV 3 legal protocols for legal, compliance, discrimination, or regulatory exposure.
  • Maintain precise documentation in Zendesk and the escalation tracker, applying granular themes, reason codes, and ownership tags to enable reliable root-cause reporting.
  • Identify escalation trends and drive macro, playbook, and process improvements that reduce recurrence and prevent repeat escalations.

Qualifications

  • Bachelor’s degree in Healthcare Administration, Business, Communications, or related field preferred, or equivalent experience; 3+ years in escalation management, member/customer advocacy, health benefits, or healthcare operations.
  • Experience resolving complex, multi-stakeholder escalations; strong knowledge of employer-sponsored benefits, reimbursement and claims workflows, and the fertility/family-building member journey.
  • Familiarity with Zendesk, Jira, Guru, Google Sheets, and Looker.
  • Highly organized and detail-oriented, with strong critical thinking, root-cause analysis, and structured case management skills.
  • Excellent verbal and written communication, with strong de-escalation skills and the ability to translate complex benefits and billing issues into clear resolution plans.
  • Sound legal and risk judgment, with the ability to identify when to involve Legal, Compliance, or leadership and collaborate effectively across teams.
  • Empathetic, composed, and member-centric, with the ability to navigate high-emotion, high-stakes cases through resolution.

Skills

Required:Escalation managementZendeskCross-functional collaborationCommunication and de-escalation

Benefits

  • Maven for Mavens: access to the full platform and specialists, including care for mental health, reproductive health, family planning and pediatrics
  • Whole-self care through wellness partnerships
  • Hybrid work, in office meals, and work together days
  • 16 weeks 100% paid parental leave and new parent stipend (for Mavens who've been with us for 1 year+)
  • Annual professional development stipend and access to a personal career coach through Maven for Mavens
  • 401K matching for US-based employees, with immediate vesting
Last updated Sep 23, 2026. Interested? Apply on the company site.

About Maven Clinic

The next generation of care for women and families

Maven helps companies retain talent, improve health outcomes, and reduce maternity and fertility costs. We support every path to parenthood: Pregnancy, Fertility, Egg Freezing, Adoption, Surrogacy, Infant Care, Breastmilk Shipping, and Manager Training.

Women's healthFamily healthVirtual careFertilityPregnancyInfertilityParentingMenopause
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