Government Employees Health Association, Inc.
Health Insurance
ManagerExecutiveEscalations
“Manager -Executive Escalations at Government Employees Health Association, Inc.. Skills: Executive Escalations, People Leadership, Risk Management. Lead, coach, and develop a team. Establish clear performance expectations”
What You'll Achieve.
Timely resolution of escalations; Accurate resolution of escalations; Reputationally sound resolution of escalations; Meet service level expectations; Meet quality expectations; Improve processes; Improve claims accuracy; Improve customer experience
Industry & Context.
Investigative rigor; Root cause analysis; Critical-thinking skills
High Speed Internet Service, Minimum speed 30x5, Latency lower than 80 ms, Dedicated space
What They're Looking For.
Must Have
Bachelor's degree in a related field, 5-8 years of experience in a medical and/or dental health plan environment, Minimum of 3 years of people management experience, Minimum of 2 years of demonstrated experience in implementing Lean management principles, Extensive knowledge of medical terminology, Extensive knowledge of claims adjudication processes, Extensive knowledge of regulatory considerations, Demonstrated ability to lead, coach, and develop high-performing teams, Advanced analytical skills, Advanced investigative skills, Advanced critical-thinking skills, Exceptional written communication skills, Exceptional verbal communication skills, Ability to summarize and present insights using Excel, Ability to summarize and present insights using PowerPoint, Ability to summarize and present insights using Power BI
Nice to Have
Experience leading teams handling complex escalations, Experience leading teams handling complex investigations, Experience executing process improvement initiatives
What You'll Do.
Establish clear performance expectations
Conduct performance reviews
Provide ongoing feedback
Provide development planning
Ensure appropriate workload distribution
Ensure escalation protocols
Foster a culture of professionalism
Foster a culture of accountability
Foster a culture of discretion
Foster a culture of member advocacy
Provide oversight on sensitive escalations
Provide oversight on complex escalations
Provide oversight on high-risk escalations
Serve as a management escalation point
Ensure consistent communication with members
Ensure consistent communication with providers
Ensure consistent communication with senior leaders
Ensure consistent communication with external stakeholders
Ensure accurate communication with members
Ensure accurate communication with providers
Ensure accurate communication with senior leaders
Ensure accurate communication with external stakeholders
Ensure empathetic communication with members
Ensure empathetic communication with providers
Ensure empathetic communication with senior leaders
Ensure empathetic communication with external stakeholders
Establish investigative standards
Maintain investigative standards
Ensure escalations are resolved accurately
Ensure escalations are resolved compliantly
Partner closely with operations
Partner closely with pharmacy
Partner closely with dental
Partner closely with customer service
Partner closely with vendors
Lead cross-functional working sessions
Participate in cross-functional working sessions
Oversee tracking of executive-level escalations
Oversee reporting of executive-level escalations
Oversee analysis of executive-level escalations
Identify recurring issues
Identify systemic breakdowns
Translate insights into actionable recommendations
How You'll Work.
Team & Collaboration
Cross-functional partners; Cross-functional working sessions
Communication Scope
Executive-level correspondence; Executive-level communication
Process & Methodology
Lean management principles, Process improvement initiatives
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