Sr. Executive Response Specialist

Sr. Executive Response Specialist

GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) 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.

GEHA 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, GEHA 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.

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 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 :

Preferred Qualifications :

Work-at-home requirements :

How we value you :

While this is a remote opportunity, at this time GEHA 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. GEHA 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 annual base salary range for this position is $48,970 - $69,030 USD. GEHA 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. GEHA 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.

GEHA 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.