[Hiring] Escalated Issue Resolution Specialist @Personify Health

Role Description

Ready to take the toughest member issues from “urgent” to “resolved”? 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.

• 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

• 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
• 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

• 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