Health Escalations Agent

Health Escalations Agent responsible for handling customer complaints, queries, and escalations for Kaelo's health insurance clients. Responsibilities include receiving and managing complaints through the workflow system, investigating by gathering information and documents, responding to members and providers professionally, providing first responses and updates within service levels, keeping accurate records, capturing complaint details for reporting, performing root cause and preventative actions, escalating complex matters to management, collaborating with internal departments to drive resolution, and supporting audits, reporting, and continuous improvement while maintaining high standards of customer service, quality, and compliance. Strong written and verbal communication, investigation and problem-solving skills, attention to detail, ability to work under pressure, and understanding of SLA-driven environments are required or beneficial.