Supervisor, Member Escalations & Benefits Correspondence

Imagine360 is seeking a Supervisor, Member Escalations & Benefits Correspondence to join the team! 

The Supervisor, Member Escalations & Benefits Correspondence is responsible for overseeing escalated member issues and supervising staff who manage written benefit-related inquiries, including benefits, claims status, eligibility, predeterminations, and other benefit-related requests. This role ensures timely, accurate, high-quality, and compliant responses to escalated call situations and benefits correspondence while maintaining white-glove service, expedient turnaround standards, and an effortless member and provider experience.

The Supervisor provides daily guidance, coaching, quality oversight, workflow coordination, and operational support to ensure team efficiency, accuracy, and adherence to organizational service expectations. This position requires exceptional communication, proven leadership experience, strong problem-solving skills, and the ability to calmly navigate high-visibility escalations while supporting team members in a fast-paced, dynamic environment.

Position Location: 100% remote

Responsibilities include but are not limited to:

Supervisory Responsibilities

• Provide day-to-day coaching, support, supervision, and development to staff handling escalations and benefits correspondence.
• Conduct regular performance evaluations and monitor quality, productivity, utilization, schedule adherence, and performance goals.
• Deliver corrective action when appropriate, including coaching, documentation, and follow-up.
• Lead monthly team meetings, 1:1s, and ongoing development conversations that support performance and build bench strength within the team.
• Serve as the primary point of contact for questions, escalation assistance, and process clarification.
• Support change management efforts while promoting a positive, supportive, service-focused culture.

Escalations & Benefits Correspondence Oversight

• Manage escalated or sensitive member issues requiring advanced intervention beyond frontline agents.
• Review, triage, and prioritize escalations to determine next steps, ensuring urgent and non-urgent criteria and response expectations are met.
• Lead staff responsible for written inquiries regarding benefits, claims status, eligibility, predeterminations, and other benefit-related requests.
• Ensure outgoing correspondence meets quality, accuracy, compliance, production, and turnaround standards.
• Support staff in resolving complex benefit inquiries requiring research, judgment, or collaboration across departments.
• Provide wrap-up communication to leadership as appropriate for high-visibility cases.

Team Management, Workflow Coordination & Quality

• Distribute and monitor daily workloads to ensure appropriate coverage across correspondence and escalations.
• Coordinate incoming work queues and ensure efficiency across functions.
• Track team productivity, quality, schedule adherence, email quality, production goals, and turnaround times.
• Review quality audits, provide targeted coaching, and guide staff toward performance improvements.

Process Improvement, Communication & Collaboration

• Partner with internal teams, including Client Experience, Medical Management, Provider Services, Correspondence, Member Services, Clinical teams, and other stakeholders to support resolution of escalations and high-impact issues.
• Act as liaison across departments to support timely resolution and consistent communication.
• Communicate trends, issues, and updates to leadership and recommend action steps.
• Identify opportunities to streamline processes, improve efficiency, and enhance the member experience.
• Partner with leadership on new system or process implementations impacting escalations or correspondence.
• Ensure SOPs, training materials, and workflows are followed and provide feedback for improvements.

Required Skills & Competencies

• Strong written and verbal communication skills with the ability to resonate with others to impact positive outcomes.
• Ability to manage complex escalations with professionalism and empathy.
• High attention to detail with strong analytical and established problem-solving skills.
• Ability to coach, mentor, and develop team members with varying experience levels.
• Ability to manage multiple priorities, implement solutions with little supervision, and provide supervision and mentorship in a fast-paced environment.
• Strong technology skills, including Microsoft products.
• Strong knowledge of benefits, claims, correspondence, member services, healthcare operations, and member experience workflows.

Education & Experience

• Prior leadership experience required in a supervisory, management, or lead role.
• Proven experience in a service environment required.
• Experience in benefits, claims, correspondence, member services, healthcare operations, or the healthcare benefits/insurance industry preferred.
• College degree preferred, or a combination of some college and applicable work experience.

Physical Requirements:

• Travel away from home may be required.

Imagine360 will make reasonable accommodations to enable applicants to participate in the interview process and other aspects of the hiring process, as well as for current employees, when Human Resources is aware of the need for such accommodations.

I understand that it is my responsibility to contact Human Resources if I need the company to consider making any accommodations to enable me to participate in the hiring process, including the interview, or for any of the job activities, duties or responsibilities included in this Job Description for any of the following reasons:

1. Physical or mental health condition;
2. Pregnancy or childbirth or medical conditions relating to the same; or
3. Religious belief, practice or observance.

What can Imagine360 offer you?

• Multiple Health plan options

• Company paid employee premiums for disability and life insurance

• Parental Leave Policy

• 20 days PTO to start / 10 Paid Holidays

• Tuition reimbursement

• 401k Company contribution

• Company paid Short & Long term Disability plus Life Insurance

• Professional development initiatives / continuous learning opportunities

• Opportunities to participate in and support the company's diversity and inclusion initiatives

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**