Member Support Specialist, Grievances

Own and resolve high-priority, complex, or sensitive member escalations end-to-end.
Serve as the “last line” point of contact for unresolved member concerns.
Investigate grievances thoroughly, synthesizing information from multiple systems and stakeholders.
Ensure timely, compliant, and well-documented resolution of all escalations.
Review and assess accommodation and accessibility requests with sound judgment and consistency.
Evaluate supporting documentation, including authorized representative forms and related records.
Determine appropriate next steps, including approvals, denials, or escalations.
Partner with internal teams to ensure accommodations are implemented and documented effectively.
Communicate professionally and clearly with health plans, providers, and external partners.
Adapt communication style based on audience (members, executives, clinical and member support teams, partners).
Translate complex issues into actionable insights for internal stakeholders.
Lead de-escalation efforts with empathy, professionalism, and control.
Make independent, high-stakes decisions within established guidelines.
Identify when to escalate issues further vs. resolve directly.
Recognize patterns and recommend improvements to reduce future escalations.
Experience
Reliable high speed internet access with minimum speeds of roughly 100 Mbps download and 20 Mbps upload.
A completely private, secure, and quiet workspace.
Bachelor’s degree or higher.
3–5+ years in member/patient support, escalations, grievances, or case management.
Experience working with health plans, healthcare systems, or regulated environments preferred.
Demonstrated experience handling complex escalations or complaint resolution.
Familiarity with accessibility and accommodation processes (preferred).
Experience reviewing formal documentation (e.g., authorized representative forms, medical or legal documentation) is a plus.
Salary and Perks
Pay range: $65K - $70K
Unlimited PTO
Flexible & remote location
Healthcare Coverage (Medical, Dental, Vision)
401k & bonus
Registered Dietitian Sessions
About Foodsmart
A digital personal nutrition expert.

Skills
Documentation

Work arrangement
Yes