Customer Advocacy Team Lead

Antidote Health is a tech‑driven health insurance company on a mission to make healthcare easy, accessible, and more affordable. We’re rethinking how healthcare works—using technology to remove the friction, complexity, and delays that define the traditional system. Instead of navigating paperwork, long waits, and disconnected experiences, we’re building a simpler, more connected way for people to get care.

Our platform combines health coverage, virtual care, and a modern member experience into one seamless system designed to help people actually use their benefits.

We offer Affordable Care Act (ACA) health plans in Arizona and Ohio, and we’re growing quickly. We’re building a company focused on solving real problems—with real impact on people’s lives.

The Customer Advocacy Team Lead oversees the day‑to‑day execution of Tier 3 complaint, advocacy, and regulatory workflows. This role reviews response quality, manages complaint inventory, supports deadline compliance, coaches specialists, coordinates root cause analysis, and helps ensure that escalated matters are handled with accuracy, neutrality, and regulatory discipline. This role may be performed remotely, but we have a strong preference for hybrid, with two days a week in our New York City office.

• Monitor daily complaint, regulatory, executive escalation, appeals, grievance, BBB, CMS, HICS, and state DOI inventory.
• Assign work, track deadlines, manage aging, and leverage risks to the Manager, Customer Advocacy & Regulatory Affairs.
• Review investigation summaries, regulatory drafts, customer communications, and supporting documentation for accuracy, completeness, tone, and compliance alignment.
• Coach Customer Advocacy Specialists on investigation quality, writing, evidence review, deadline management, and root cause analysis.
• Coordinate with Compliance, Legal, Claims, Billing, Finance, Enrollment, Network, Clinical Operations, Product, Tier 1, and Tier 2 to support timely response development.
• Maintain complaint logs, trackers, templates, response standards, and audit support documentation.
• Conduct trend reviews, identify repeat complaint patterns, and recommend corrective action opportunities.
• Support NCQA, CMS, DOI, internal audit, and quality committee reporting preparation.
• Ensure privacy, HIPAA, CMS, ACA, state, and company requirements are followed consistently.
• Model precise writing, professional judgment, regulatory awareness, and customer advocacy.

• 5 or more years of healthcare, health insurance, appeals, grievances, regulatory operations, customer operations, compliance support, or escalations experience.
• 2 or more years of senior specialist, lead, coaching, or regulatory workflow coordination experience.
• Strong writing review, investigation, documentation, compliance, and organizational skills.
• Experience managing deadlines, escalated cases, and sensitive customer matters.
• Ability to coach staff and maintain consistent standards across complex work.
• High school diploma or GED required.
• Completion of leadership essentials, HIPAA, quality calibration, and performance coaching training required.

• NCQA, CMS, HICS, ODI, DIFI, BBB, state DOI, or health plan complaint experience.
• Experience building complaint logs, regulatory templates, response frameworks, or corrective action trackers.
• Experience supporting audits, quality committees, compliance reviews, or formal reporting.
• Experience with Salesforce, case management, SharePoint, document management, and reporting tools.
• Associates or Bachelors degree is preferred.
• Ownership and accountability: works issues to resolution rather than transferring responsibility unnecessarily.
• Member and customer advocacy: seeks to understand the customer goal, the barrier, the accountable owner, and the fastest compliant path to resolution.
• Clear communication: translates benefits, eligibility, deductibles, claims, referrals, prior authorization, premiums, and other healthcare concepts into plain language.
• Critical thinking: identifies root causes, asks investigative questions, and recognizes when an issue does not align with expected process or system…