Member Support Specialist (Escalations & Grievances)

This role serves as the final point of contact for complex member issues, including health plan grievances, RD grievances, and advanced member account support and food benefits escalations This individual is responsible for resolving highly sensitive situations that require strong judgment, cross-functional coordination, and nuanced communication with members, health plans, and internal stakeholders Own and resolve high-priority, complex, or sensitive member escalations end-to-end Own all escalations and grievances relating to RDs end to end, and collaborate with the Clinical Operations team to manage and document these effectively Investigate RD reports of member behavior and safety concerns Serve as the “last line” point of contact for unresolved member concerns in their scope Investigate escalated or complex member and internal requests relating to member profile and food benefit issues Ensure timely, compliant, and well-documented resolution of all escalations Communicate professionally and clearly with health plans, providers, and external partners Adapt communication style based on audience (members, executives, clinical and member support teams, partners) Translate complex issues into actionable insights for internal stakeholders Manage and elevate benefit and account issues to the engineering and product team, and manage ongoing requests and projects with these groups Lead de-escalation efforts with empathy, professionalism, and control Maintain communication standards by monitoring the quality of communication around benefit programs and account issues between member support and members Ensure internal and external resources outlining benefits programs are current and accurate Make independent, high-stakes decisions within established guidelines Identify when to escalate issues further vs. resolve directly Recognize patterns and recommend improvements to reduce future escalations Success in this role looks like: Complex escalations are resolved efficiently and thoughtfully Members and RDs feel heard and supported—even in difficult situations Health plan and partner communications are clear, professional, and effective Trends in escalations are identified and fed back to improve the overall member experience Emerging product and engineering issues are escalated in a timely manner, and ongoing issues are contributed to and closely monitored Benefits Paid health insurance Flexible working location Flexible working hours Unlimited PTO 401k, bonus & stock options The ideal candidate brings advanced critical thinking, emotional intelligence, and the ability to tackle advanced issues while ensuring members and RDs feel heard, supported, and respectedAdvanced Critical Thinker: Ability to assess complex, ambiguous situations and determine the best course of actionAgile in Communication: Strong written and verbal communication skills with the ability to tailor tone and messaging across audiencesTechnically Proficient: Established acumen for technically intricate situations, and capable of communicating effectively with product and engineering teamsSound Judgment: Trusted to make decisions on sensitive accommodation and escalation casesDe-escalation & Mediation Minded: Proven ability to manage high-emotion interactions and drive resolutionDetail Orientated: Strong documentation and compliance mindset, especially with sensitive or regulated processesEmpathetic with Authority: Can create a supportive experience while maintaining control and direction of the conversationA completely private, secure, and quiet workspaceReliable high speed internet access with minimum speeds of roughly 100 Mbps download and 20 Mbps uploadExperience working in technically complex rolesDemonstrated experience handling complex escalations or complaint resolution1–3+ years in member/patient support, escalations, grievances, or case managementExperience working with health plans, healthcare systems, or regulated environments preferred #J-18808-Ljbffr Foodsmart