Resolution Response Specialist

About the Role:

Maven is looking for a Resolution Response Specialist who will lead the end-to-end resolution of complex, high-risk member escalations, serving as a Tier 2 senior owner within the Resolution Response Team to ensure every escalation is handled consistently, efficiently, and at the right level the first time — restoring member trust while protecting Maven, its clients, and its members.

This is a non-exempt, Monday–Friday position with hours of 8:30 a.m.–5:00 p.m. ET and occasional weekend coverage as needed.

What You’ll Do:

• Own escalated member cases end-to-end, serving as the single accountable owner for moderate-to-high complexity issues across billing, reimbursement, benefits, coordination of benefits, network exceptions, and service breakdowns.
• Conduct structured investigations using the established triage framework (Category → Owner → Macro → Checklist → SLA → Escalation Path), reviewing ticket history, call recordings, prior guidance, client documentation, spend, and reimbursement records before resolution.
• Lead service recovery by reviewing low-rated interactions, conducting proactive outreach (call-first where possible), applying de-escalation protocols, and confirming closed-loop resolution with a written member recap.
• Serve as the primary cross-functional bridge across MBS, 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 CSMs with concise case summaries and polished client-facing messaging when needed.
• 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 the 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.

What You’ll Bring:

• 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 the ability to translate complex benefits and billing issues into clear resolution plans.
• Sound legal and risk judgment, with the ability to identify when to involve Legal, Compliance, or leadership and collaborate effectively across teams.
• Empathetic, composed, and member-centric, with the ability to navigate high-emotion, high-stakes cases through resolution.

The base salary range for this role is $82,000 - $96,000 per year. You will also be entitled to receive equity and benefits. Individual pay decisions are based on a number of factors, including qualifications for the role, experience level, and skillset.

Maven embraces a flexible and inclusive work environment. This role is open to candidate in: AZ, DC, DE, FL, GA, HI, IL, KS, MA, MD, ME, MI, MN, MO, NC, NJ, NM, NV, NY, OH, OR, PA, SC, TN, TX, VA, VT, WI. Maven is committed to supporting remote team members with the tools and collaborative culture needed to thrive regardless of location. This policy reflects our belief that great work can happen anywhere and that flexibility enables our team to do their best work.