Manager Executive Escalations (Health Insurance)

TL;DR

Manager Executive Escalations (Health Insurance): Leading and overseeing the resolution of complex, sensitive, and high-profile medical and dental escalations with an accent on investigative rigor and stakeholder engagement. Focus on root cause analysis, implementing Lean management principles, and mitigating reputational risk through systemic process improvements.

Location: Remote (USA). Not hiring in US territories or the following states: AK, HI, CA, WA, OR, CO, WY, MT, NY, CT, VT, PA, ME

Salary: $92,711 - $117,285 USD (Target range)

Company

hirify.global is a nonprofit member association providing comprehensive health and dental benefits to millions of federal employees, retirees, and their families.

What you will do

• Lead, coach, and develop a team of Executive Escalation Specialists responsible for end-to-end resolution of complex cases.
• Provide oversight and guidance on high-risk escalations, including OPM grievances and compliance concerns.
• Establish and maintain investigative standards for root cause analysis, claims review, and eligibility validation.
• Partner with operations, pharmacy, dental, and customer service teams to resolve systemic issues.
• Oversee tracking and analysis of escalation trends to provide actionable recommendations for process improvement.

Requirements

• Bachelor's degree in a related field.
• 5-8 years of experience in a medical and/or dental health plan environment.
• Minimum 3 years of people management experience leading teams in complex escalations or investigations.
• Minimum 2 years of experience implementing Lean management principles and process improvement.
• Must be based in the USA (excluding specified restricted states).
• Must have non-cellular high-speed internet (30/5 Mbps) with latency below 80ms and a dedicated quiet workspace.

Culture & Benefits

• Health, Vision, and Dental benefits effective on day one.
• 401(k) retirement plan with dollar-for-dollar match up to 4% plus a 6% annual company contribution.
• Paid Time Off and Personal Community Enrichment Time.
• Tuition Assistance Program and robust employee well-being program.
• Company-provided Basic Life, AD&D, and Short-Term/Long-Term Disability.