Manager -Executive Escalations

Job Summary

Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care.

G.E.H.A has one mission:
To empower federal workers to be healthy and well. The Manager, Executive Escalations reports to the VP – Product Development and leads and oversees G.E.H.A’s Executive Escalations function, ensuring the timely, accurate, and reputationally sound resolution of the organization’s most complex, sensitive, and high‑profile medical and dental escalations.

• Lead, coach, and develop a team of Executive Escalation Specialists responsible for end‑to‑end resolution of complex medical and dental escalations. Establish clear performance expectations, conduct performance reviews, and provide ongoing feedback and development planning. Ensure appropriate workload distribution, coverage, and escalation protocols to meet service level and quality expectations. Foster a culture of professionalism, accountability, discretion, and strong member advocacy.
• Provide oversight and guidance on the most sensitive, complex, or high‑risk escalations, including OPM grievances, leadership‑referred cases, and compliance concerns. Serve as a management escalation point for cases requiring advanced judgment or executive‑level communication. Ensure consistent, accurate, and empathetic communication with members, providers, senior leaders, and external stakeholders.
• Establish and maintain investigative standards for root cause analysis, including claims review, eligibility validation, audit of calls and correspondence, and process flows. Ensure escalations are resolved accurately, compliantly, and with long‑term systemic solutions in mind. Apply sound judgment to balance member experience, regulatory requirements, contractual obligations, and reputational risk.
• Partner closely with operations, pharmacy, dental, customer service, and vendors to resolve escalations and mitigate risk. Lead or participate in cross‑functional working sessions addressing systemic issues surfaced through executive escalations.
• Oversee tracking, reporting, and analysis of executive‑level escalations, trends, and outcomes. Identify recurring issues and systemic breakdowns in the member journey. Translate insights into actionable recommendations to improve processes, claims accuracy, and customer experience.

• Bachelor’s degree in a related field required.
• 5‑8 years of experience in a medical and/or dental health plan environment.
• Minimum of 3 years of people management experience, preferably leading teams handling complex escalations or investigations.
• Minimum of 2 years of demonstrated experience in implementing Lean management principles and executing process improvement initiatives.
• Extensive knowledge of medical terminology, claims adjudication processes, and regulatory considerations.
• Demonstrated ability to lead, coach, and develop high‑performing teams.
• Advanced analytical, investigative, and critical‑thinking skills.
• Exceptional written and verbal communication skills, including executive‑level correspondence.
• Strong judgment in managing sensitive situations and reputational risk.
• Ability to summarize and present insights using Excel, PowerPoint, and/or Power BI.

Must have the ability to provide a non‑cellular high‑speed internet service such as Fiber, DSL, or cable modems for a home office. A minimum standard speed of 30mbps download and 5mbps upload is required. Latency (ping) response time lower than 80ms. Hotspot, satellite and wireless internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

• Competitive pay/salary ranges with incentive plan.
• Health/Vision/Dental benefits effective day one.
• 401(k)…