Escalated Issue Resolution Specialist
Overview
Who We Are Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Learn even more about the work that drives us at personifyhealth.com.
Responsibilities
Ready to take the toughest member issues from “urgent” to “resolved”? Why This Role Matters When a member’s claim, coverage, or access to care hits a wall, the stakes get personal fast, and someone has to step in and own it. That someone is you. As our Escalated Issue Resolution Specialist, you take the problems that cross systems, teams, and partners, and you don’t let go until they’re fixed and confirmed closed. Your work protects members from delays that affect their care and their finances, and it shows clients that we act decisively when it counts. The patterns you uncover also make our processes stronger, so fewer members hit these walls in the first place. Every issue you close cleanly builds trust in Personify Health, one resolution at a time. What You’ll Actually Do Own escalations from intake to closure: Take immediate ownership of urgent issues and stay accountable through final resolution, so nothing stalls or falls through the cracks. Assess scope, urgency, and risk: Quickly size up each escalation to determine what’s at stake and which actions, systems, and teams are needed to move it forward. Investigate complex cases: Dig into issues involving claims, billing, eligibility, access to care, pre-certification, or coverage, using multiple internal and external systems to find the root cause. Coordinate across teams and partners: Mobilize Claims, Utilization Review, Case Management, Finance, Stop Loss, and external partners such as providers, carriers, and vendors, assigning responsibilities and deadlines and following up until the work is done. Fix breakdowns between systems and processes: Identify where handoffs, systems, or workflows are causing delays or errors, and resolve them so the issue stays solved. Escalate with a plan: When barriers surface, bring leadership clear recommendations and next steps rather than just the problem. Confirm documentation and system updates: Make sure required clinical information, documents, and system updates are obtained, routed correctly, and confirmed received. Keep stakeholders informed: Provide proactive status updates, timelines, and outcomes, including executive-level updates when needed, so everyone knows where things stand. Document every step: Record investigative steps, decisions, communications, and outcomes accurately to support transparency and audit readiness. Validate and close: Confirm the final resolution is accurate, formally close the issue, and make sure no loose ends remain. Surface trends for improvement: Analyze patterns across escalated issues and share findings with leadership to drive process improvements.
Qualifications
What You Bring to Our Team Education & Experience: 3+ years of experience in member services, claims, escalations, or healthcare operations Prior experience handling escalated, urgent, or high-risk cases strongly preferred Experience working across multiple healthcare systems, vendors, or operational teams Technical Skills: Working knowledge of claims, billing, eligibility, pre-certification, and coverage processes Familiarity with Utilization Review, Case Management, and Stop Loss functions Ability to navigate and synthesize information across multiple systems, data sources, and workflows Proficiency in case tracking and documentation, including audit-ready record keeping
Benefits
The Highlights: Competitive base salary and benefits effective day one Comprehensive medical and dental through our own health solutions (yes, we use what we build) Paid Time Off—rest and recharge time is non-negotiable Mental health support, retirement planning, and financial protection Professional development with clear career progression and learning budgets Mission-driven culture where diverse perspectives drive real impact on people's health Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. Compensation: This position offers a base salary range of $21-$25 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one. Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing. Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to [email protected]. View all legitimate openings at personifyhealth.com/careers.