Manager, Customer Advocacy & Regulatory
The Manager, Customer Advocacy & Regulatory Affairs provides strategic leadership for regulatory complaints, appeals and grievances, executive escalations, complaint trend management, agency response operations, audit readiness, and corrective action follow-through. This role ensures that Antidote Health responds to high-sensitivity matters accurately, timely, neutrally, and in alignment with regulatory and organizational standards.
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 Manager, Customer Advocacy & Regulatory Affairs provides strategic leadership for regulatory complaints, appeals and grievances, executive escalations, complaint trend management, agency response operations, audit readiness, and corrective action follow-through. This role ensures that Antidote Health responds to high-sensitivity matters accurately, timely, neutrally, and in alignment with regulatory and organizational standards. Antidote Health's mission is to redefine healthcare by providing affordable, high-quality, accessible care and insurance products. The Customer Success organization supports that mission by making healthcare easier to understand, easier to access, and easier to navigate for members, brokers, patients, providers, and internal partners.
Key Responsibilities
- Lead Tier 3 Customer Advocacy and Regulatory Affairs operations, including complaints, appeals, grievances, agency inquiries, CMS or HICS matters, DOI matters, BBB matters, and executive escalations.
- Establish and maintain regulatory response standards, complaint log requirements, quality review routines, deadline management processes, and escalation protocols.
- Manage Team Lead and Specialist performance, development, workload, coaching, and accountability.
- Partner with Compliance, Legal, Clinical Operations, Billing, Finance, Claims, Enrollment, Network, Product, Engineering, Sales, Tier 1, and Tier 2 on factual investigation and corrective actions.
- Ensure responses are clear, factual, neutral, complete, timely, and aligned with legal, compliance, and operational review standards.
- Lead complaint trend analysis, root cause identification, corrective action tracking, and executive reporting.
- Support NCQA, CMS, state DOI, quality committee, internal audit, and external audit preparation.
- Develop templates, SOPs, response frameworks, trackers, and quality controls that reduce risk and improve consistency.
- Brief senior leadership on complaint trends, regulatory exposure, operational defects, corrective actions, and customer impact.
- Build a culture of accountability, discretion, regulatory discipline, customer advocacy, and continuous improvement.
Qualifications
Required
- 5 or more years of healthcare, health insurance, compliance operations, regulatory operations, appeals and grievances, complaint management, or customer operations experience.
- 3 or more years of leadership experience, including direct or indirect management of regulatory, advocacy, escalations, or customer operations staff.
- Strong understanding of CMS, ACA, state DOI, appeals and grievances, complaint management, HIPAA, privacy, audit readiness, and corrective action practices.
- Excellent executive writing, review, investigative, analytical, and stakeholder management skills.
- Demonstrated ability to manage high-risk matters, deadlines, regulatory reviews, and cross-functional accountability.
Preferred
- NCQA, CMS, HEDIS, HICS, state DOI, quality committee, legal operations, or compliance audit experience.
- Experience in ACA marketplace health plans or start-up health insurance environments.
- Experience presenting regulatory trends to executives or committees.
- Project management, compliance, healthcare administration, or quality improvement certification
- Bachelor degree in healthcare administration, business, public health, legal studies, compliance, communications, or related field preferred.
- Advanced degree, compliance certification, project management certification, or quality certification preferred.
Work Shift and Training Expectations
- Shift flexibility may be required based on operational needs, including extended hours, overtime, weekends, holidays, or Open Enrollment Period support.
- Specific shift assignments are based on business needs and should be confirmed during the recruiting and offer process.
- 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.
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
Compensation and Benefits
- Base salary range: $88,000-115,000 (commensurate with experience and location)
- Comprehensive benefits package including medical, dental, vision
- 401(k)
- Paid vacation and sick time and company holidays
- This role is eligible to be performed remotely
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.
