Escalations Support Specialist (Remote but local to Cleveland)

Escalation Support Specialist Remote but must be local to Cleveland, OH

MetLife Legal Plans | SkySource Solutions

Location: 100% Remote, must be local to Cleveland, OH
Training: One week of required onsite training
Pay: $20.00 per hour
Schedule: Monday through Friday, 8:00 AM to 5:00 PM EST
Contract Length: 6 months to 1 year, with the possibility of full-time hire

Position Overview

SkySource Solutions is seeking an Escalation Support Specialist to support MetLife Legal Plans. This position supports the claims function by handling resolution-focused activities, including member escalations, fee reimbursement appeals, complaints, denial communications, and complex claim inquiries. The ideal candidate will have strong investigative, analytical, and communication skills with the ability to professionally handle sensitive and complex member concerns.

Key Responsibilities

• Review and respond to escalated member inquiries received from Customer Service, Client Services, leadership teams, and other internal stakeholders.
• Investigate member complaints, including executive, presidential, BBB, DOI, and other regulatory complaints.
• Investigate complex claim and reimbursement issues to determine appropriate resolutions.
• Compile claim histories, supporting evidence, documentation, and case timelines.
• Draft professional complaint responses for management review.
• Coordinate with internal partners to obtain information necessary for complaint and claim resolution.
• Communicate with members and internal departments regarding claim status, decisions, resolutions, and next steps.
• Review claim determinations and supporting documentation.
• Prepare and send fee reimbursement denial letters in accordance with established claim determination guidelines.
• Ensure denial letters clearly explain the reason for denial and any available appeal rights.
• Respond to member questions regarding denial determinations and appeal procedures.
• Maintain accurate records and supporting documentation for complaints, escalations, and denial communications.
• Maintain resolution tracking logs and ensure timely follow-up on open issues.
• Handle sensitive and confidential member information appropriately.

Qualifications

• Strong investigative, analytical, and problem-solving skills.
• Excellent written and verbal communication skills.
• Strong professional correspondence and documentation abilities.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities and cases in a high-volume environment.
• Ability to professionally handle escalated or sensitive member concerns.
• Proficiency with Microsoft Outlook, Excel, and Word.
• Experience with case tracking, claims, CRM, or similar systems preferred.
• Ability to maintain confidentiality and appropriately handle sensitive information.

Preferred Experience

Candidates with previous experience in claims, insurance, benefits, legal services, escalations, appeals, complaint resolution, case management, or customer service are strongly encouraged to apply.

SkySource Solutions believes in attaining success. We know success is important to our clients, applicants, candidates, and our internal staff and want to be an integral part of that process.
The SkySource Difference: We are not just another staffing firm! We truly care about our candidates long-term success and how we get there together. So the BIG Question is... How do we get there?
Our team of Recruiters come with 5 plus years of industry experience and are not looking to just find you a job. We truly care about your short-term and long-term career goals and understand what's important in making that next career move. We want to understand what you are looking for from a cultural, compensation and benefits perspective.

Apply today and experience the SkySource difference!