Manager -Executive Escalations

Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. G.E.H.A has one mission: To empower federal workers to be healthy and well. The Manager, Executive Escalations reports to the VP – Product Development and leads and oversees G.E.H.A.’s Executive Escalations function, ensuring the timely, accurate, and reputationally sound resolution of the organization’s most complex, sensitive, and high-profile medical and dental escalations. This role is responsible for handling executive escalations and managing a team of Executive Escalation Specialists, setting standards for investigative rigor, communication quality, and stakeholder engagement, and serving as a key liaison between cross-functional partners. SKILLS Duties and Responsibilities: People Leadership & Team Management Lead, coach, and develop a team of Executive Escalation Specialists responsible for end-to-end resolution of complex medical and dental escalations. Establish clear performance expectations, conduct performance reviews, and provide ongoing feedback and development planning. Ensure appropriate workload distribution, coverage, and escalation protocols to meet service level and quality expectations. Foster a culture of professionalism, accountability, discretion, and strong member advocacy. Executive Escalation Oversight Provide oversight and guidance on the most sensitive, complex, or high-risk escalations, including OPM grievances, leadership-referred cases, and compliance concerns. Serve as a management escalation point for cases requiring advanced judgment or executive-level communication. Ensure consistent, accurate, and empathetic communication with members, providers, senior leaders, and external stakeholders. Investigation, Quality & Risk Management Establish and maintain investigative standards for root cause analysis, including claims review, eligibility validation, audit of calls and correspondence, and process flows. Ensure escalations are resolved accurately, compliantly, and with long-term systemic solutions in mind. Apply sound judgment to balance member experience, regulatory requirements, contractual obligations, and reputational risk. Cross-Functional Partnership Partner closely with operations, pharmacy, dental, customer service, and vendors to resolve escalations and mitigate risk. Lead or participate in cross-functional working sessions addressing systemic issues surfaced through executive escalations. Reporting, Trends & Continuous Improvement Oversee tracking, reporting, and analysis of executive-level escalations, trends, and outcomes. Identify recurring issues and systemic breakdowns in the member journey. Translate insights into actionable recommendations to improve processes, claims accuracy, and customer experience. Knowledge, Skills, and Abilities: Bachelor’s degree in a related field required. 5-8 years of experience in a medical and/or dental health plan environment. Minimum of 3 years of people management experience, preferably leading teams handling complex escalations or investigations. Minimum of 2 years of demonstrated experience in implementing Lean management principles and executing process improvement initiatives. Extensive knowledge of medical terminology, claims adjudication processes, and regulatory considerations. Demonstrated ability to lead, coach, and develop high-performing teams. Advanced analytical, investigative, and critical-thinking skills. Exceptional written and verbal communication skills, including executive-level correspondence. Strong judgment in managing sensitive situations and reputational risk. Ability to summarize and present insights using Excel, PowerPoint, and/or Power BI . Work-at-home requirements Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time lower than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information How we value you Competitive pay/salary ranges Incentive plan Health/Vision/Dental benefits effective day one 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution Robust employee well-being program Paid Time Off Personal Community Enrichment Time Company-provided Basic Life and AD&D Company-provided Short-Term & Long-Term Disability Tuition Assistance Program While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine. Please note that the salary information is a general guideline only. G.E.H.A considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer. The target hiring range for this position is $92,711 - $117,285 USD. At G.E.H.A, the current maximum salary for this role is $130,689 USD. While initial compensation may vary based on experience and qualifications, there is a path to work toward this top rate through performance and continued growth within the organization. G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. G.E.H.A will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. G.E.H.A is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.