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Salary: USD 98,000 - 115,000 / annual
Maven Clinic is seeking a Senior Associate for the Resolution Response Team to lead end-to-end resolution of complex, high-risk member escalations. You will serve as a Tier 2 senior owner, ensuring escalations are handled consistently, efficiently, and at the appropriate level while restoring member trust and protecting Maven, its clients, and members.
Key Responsibilities:
- Own escalated member cases end-to-end as the single accountable owner for moderate-to-high complexity issues spanning billing, reimbursement, benefits, coordination of benefits, network exceptions, and service breakdowns.
- Conduct structured investigations using an established triage framework, reviewing ticket history, call recordings, prior guidance, client documentation, spend, and reimbursement records.
- Lead service recovery by reviewing low-rated interactions, conducting proactive outreach (call-first approach where possible), applying de-escalation protocols, and confirming closed-loop resolution with written member recaps.
- Serve as the primary cross-functional bridge across Member Business Services, Support, Care Delivery, Client Success, Payment Operations, Network Operations, Product, Engineering, and Legal/Compliance to coordinate corrective action and accelerate resolution.
- Communicate with members using approved macros and empathy-led, legally protective language; provide Client Success Managers with concise case summaries and polished client-facing messaging.
- Identify and route risk using Critical/High/Standard severity and SEV 2/SEV 3 legal protocols for legal, compliance, discrimination, or regulatory exposure.
- Maintain precise documentation in Zendesk and escalation tracker, applying granular themes, reason codes, and ownership tags to enable reliable root-cause reporting.
- Identify escalation trends and drive macro, playbook, and process improvements that reduce recurrence and prevent repeat escalations.
This is a non-exempt, Monday–Friday position with hours 8:30 a.m.–5:00 p.m. ET and occasional weekend coverage as needed.
Requirements:
- Bachelor's degree in Healthcare Administration, Business, Communications, or related field preferred, or equivalent experience.
- 3+ years in escalation management, member/customer advocacy, health benefits, or healthcare operations.
- Experience resolving complex, multi-stakeholder escalations; strong knowledge of employer-sponsored benefits, reimbursement and claims workflows, and the fertility/family-building member journey.
- Familiarity with Zendesk, Jira, Guru, Google Sheets, and Looker.
- Highly organized and detail-oriented, with strong critical thinking, root-cause analysis, and structured case management skills.
- Excellent verbal and written communication, with strong de-escalation skills and ability to translate complex benefits and billing issues into clear resolution plans.
- Sound legal and risk judgment, with ability to identify when to involve Legal, Compliance, or leadership and collaborate effectively across teams.
- Empathetic, composed, and member-centric, with ability to navigate high-emotion, high-stakes cases through resolution.
- Resourceful, solutions-oriented, and comfortable with shifting priorities; motivated to improve processes, build scalable playbooks, and prevent repeat escalations.
- Active work authorization in the US required.
