Senior Executive Response Specialist

G.E.H.A (Government Employees Health Association, Inc.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees.

G.E.H.A has one mission: To empower federal workers to be healthy and well.

Offering one of the largest medical 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. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization. 

The Sr. Executive Response Specialist supports, researches, and responds on behalf of G.E.H.A's Leadership Team to manage complex medical and dental issues that have been escalated to G.E.H.A’s Senior Leadership Team, OPM, compliance, among others. The Executive Response Specialist is responsible for the end-to-end handling of the escalations, including but not limited to partnering with internal and external subject matter experts to research the member or provider’s concerns, perform root cause analyses, and communicate with the members and providers.

The ideal candidate is a meticulous problem-solver and skilled communicator who thrives under pressure and consistently demonstrates professionalism and discretion. They are passionate about member advocacy, confident in navigating ambiguity, and adept at investigating and troubleshooting when information is incomplete. This role requires exceptional written and verbal communication skills, as well as the ability to collaborate across multiple teams while maintaining a relentless focus on delivering respectful and timely communication to key stakeholders.

SKILLS

Duties and Responsibilities:

• Responsible for handling medical and dental escalations submitted to the Executive Escalations team, including but not limited to:

  • Tracking and reporting on all issues.

  • Researching the member’s medical or dental claims history, call transcripts, and eligibility records, to identify any issues or errors that need to be resolved. This includes a detailed review of the claims processing.

  • Working with internal and external subject matter experts to oversee resolution, as appropriate

  • Communicating directly with the member and/or provider via email and/or phone to ensure incremental updates are communicated.

  • Communicating directly with the member, provider, and/or and final resolution is communicated.

• Responds on behalf of G.E.H.A's Leadership team, and other key stakeholders to manage complex and high-profile medical and dental escalations including OPM grievances.

• Conducts investigative research including auditing phone calls, emails, claims processing, and process flows to determine root cause.

• Highlights breakdown points in the customer journey and processes; consults with stakeholders on opportunities for improvement and/or trends.

• Partners with internal and external partners to support efforts to improve customer experience and claims processing accuracy.

• Identify areas of potential improvement to internal processes that directly impact the accuracy and speed of claims processing and associated functions.

• Coordinate and lead working meetings with cross-functional teams to review complex escalations.

• Requires a powerful sense of accountability and end-to-end ownership to ensure all escalations are resolved quickly and accurately.

• Supports projects/other duties as assigned.

Requirements: Education & Experience

• Requires a Bachelor’s degree in a related field, additional years of qualifying work experience may be considered in lieu of formal education.

• Requires a minimum of 6 years’ experience at a medical or dental insurance plan, that includes at least 3 years of senior claims processing experience, with a comprehensive understanding of the adjudication process for medical and/or dental claims.

• Requires knowledge of medical terminology, medical codes, and related reference materials.

• Experience creating collaborative and productive relationships with internal and/or external partners.

• Attention to detail with the capacity to manage multiple complex issues and deadlines effectively.

• Excellent problem solving, critical thinking, and analytic skills.

• Requires strong verbal and written communication skills and proficiency in all channels of communication at levels of the organization and with external partners.

• Demonstrates a strong understanding of reputational risk and public perception when managing member complaints.

• The ability to summarize present data and findings in MS Excel, PowerPoint, or Power BI.

• Must be able to work independently.

Preferred Qualifications

• Experience with Federal Employees Health Benefits Program (FEHBP) or Federal Employees Dental and Vision Program (FEDVIP).

• Customer Service experience.

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 hiring range for this position is $48,970 - $61,950 USD. At G.E.H.A, the current maximum salary for this role is $69,030 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. Our diversity drives innovation deepens connections and strengthens our organization.

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.