Customer Advocacy Team Lead

About the Company 

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. 

Position Overview 

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.

Key Responsibilities 

• Monitor daily complaint, regulatory, executive escalation, appeals, grievance, BBB, CMS, HICS, and state DOI inventory.
  
  
• Assign work, track deadlines, manage aging, and escalate 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

Qualifications 

Required: 

• 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.

Preferred: 

• 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.

Competencies  

• 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 behavior. 

• Calm authority: communicates findings with accuracy, confidence, and professionalism while avoiding speculation.
  
  
• Emotional intelligence and de-escalation: steadies difficult interactions and maintains professionalism under pressure.
  
  
• System fluency: navigates CRM, claims, eligibility, benefits, provider lookup, payment, scheduling, knowledge base, and case management tools efficiently.
  
  
• Compliance mindset: maintains HIPAA, privacy, CMS, ACA, state DOI, and internal policy requirements. 

• Documentation discipline: records clear, complete, and audit-ready notes that support continuity and accountability.
  
  
• Adaptability and resilience: succeeds in a fast-paced, evolving health plan environment.

Training and Work Shift Expectations

• Completion of required Antidote Health onboarding and role-based training.
  
  
• Completion of HIPAA, privacy, security, compliance, systems, and workflow training.
  
  
• Participation in quality coaching, calibration, refresher training, and ongoing competency checks as assigned.
  
  
• For frontline and specialist roles, successful completion of nesting or readiness assessments before independent queue assignment may be required.
  
  
• Shift flexibility is required based on staffing needs, contact volume, regulatory deadlines, customer demand, and Open Enrollment Period support.
  
  
• Specific shift assignments are based on business needs and should be confirmed during the recruiting and offer process

Compensation and Benefits 

• Compensations range: $37.00-$45.00/Hour (commensurate with experience and location) 

• Comprehensive benefits package including medical, dental, vision 

• 401(k)  

• Paid vacation and sick time and company holidays 

Company Standards and Expectations 

• Employment is at-will, meaning either the employee or the company may terminate employment at any time, with or without cause, in accordance with applicable law 

• Employees are expected to adhere to all company policies, including confidentiality, data protection, and code of conduct 

• Responsibilities may evolve based on business needs, and flexibility is expected as the company scales 

• Compliance with all applicable federal, state, and local laws and regulations is required 

Equal Opportunity Statement 

Antidote Health is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status under applicable law.