Escalations Specialist

Remote$55.5k - $75.5kFull-timePosted 3w ago

About the role

The Escalations Specialist manages and resolves complex member cases and escalations, acting as the team’s subject matter expert on refund-related issues, to ensure a seamless and positive member experience and drive continuous improvement.

Responsibilities

Manage and resolve escalated member cases, including partnership/network access, technology issues, refund-related concerns, and other high-priority or complex member issues.
Investigate and analyze the root causes of escalated issues, providing tailored solutions to ensure member satisfaction and loyalty.
Collaborate with other teams and external vendors/partners to resolve issues and improve member experiences.
Serve as the team’s subject matter expert for refund policy, applying established guidelines consistently across member cases, making recommendations in accordance with established policies and business guidelines.
Review and investigate complex refund requests and exception cases, making recommendations in accordance with established policies and business guidelines.
Conduct audits of refund cases and refund-related processes to ensure accuracy, policy compliance, consistency, and adherence to operational standards.
Monitor, analyze, and report on refund trends, approvals, denials, and exception requests, flagging opportunities for process improvement.
Share insights and trends from escalated cases and refund analyses with relevant teams to drive continuous improvement and prevent recurring issues.
Identify opportunities to streamline processes and improve case resolution times.
Contribute to the development and maintenance of best practices, guidelines, and documentation for handling complex member cases and refund-related processes.

Qualifications

3+ years in escalations management, customer service, or a related role.
Proven experience managing complex cases and delivering resolutions in a timely and empathetic manner.
Demonstrated experience using CRM systems, with Salesforce strongly preferred. Must be proficient in managing customer data, tracking interactions, and utilizing case management software to document, manage, and resolve member/customer inquiries and issues.
Strong communication and interpersonal skills, with the ability to manage difficult situations with professionalism and empathy.
Excellent problem-solving skills with a focus on resolution and member satisfaction.
Strong analytical skills, with the ability to identify patterns across cases and translate them into practical recommendations.
Strong time management and prioritization skills, with the ability to work effectively under pressure and handle multiple escalations at once.
Sound judgment in knowing when to independently resolve an issue versus escalating to internal management.
Excellent written communication skills, with the ability to craft clear, empathetic, member-facing responses.
Strong organizational skills and attention to detail, with the ability to document and track issues accurately.
Comfortable learning and working across multiple digital tools and platforms, including AI-assisted tools to support drafting communications and documentation efficiently.

Skills

Required:Escalation managementCRM systems (Salesforce preferred)Communication (written)Analytical thinking

Last updated Sep 30, 2026. Interested? Apply on the company site.

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