CSM ESCALATION GUIDE

QUICK REFERENCE — KEY ESCALATION OWNERS

Use the Hyperlinks to go to Issue Type

Before You Contact

Question Routing
Support Tickets & Inbound Issues
Reshop & Care Navigation

App Processing / Autopay (Manager: Brandon Lee)

QLEs (Manager: Brittany Kutcher)

Transactions / Missing Payments (Manager: Jessica Hanson)

Escalation Tickets/Access to Care (Manager: Bethany Carter)

Medicare / Inbound / Care Navigation (Managers: Laura Corvo / Amy Nordquist / Molly Brown)

Escalation Ticket Types

Determing Urgency

Ticket Creation Guide

Support Team Org Chart

BEFORE YOU CONTACT

🔍 Search HubSpot	Look up the contact in HubSpot and scan all notes, emails, open tickets first. Also check for a second contact profile when employee may reach out from a different email address than what is in benefitbay.
📋 Check open items	Is there already an open ticket or change request for this issue? Who owns it? Have I asked the ticket owner for a status update?
📊 Pull BB transaction history	For any transaction, mapping, or missing payment question — research all transactions first. Is it missing, or just a mismatch? See – Missing or Mismatch? / Viewing Banking History an Employee
⚠ Escalate	⚠ If an escalation ticket is needed, please see HubSpot Best Practices ⚠ If a CSM is sent an email thread from an employer with an issue you aren’t sure how to tackle, or if you have a smaller issue that you don’t believe needs to be a ticket: Forward or Compose Email to: support@benefitbay.com Tier 1 will triage, then escalate into a ticket, if needed.

Question Routing

OPEN SUPPORT TICKETS & INBOUND ISSUES

Open Support Ticket
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Look up the open support ticket	Review ticket details and notes	Tag ticket owner in a note Urgent? Tag manager (Laura, Amy, Molly)

Inbound Support Issue (Inbound missed calls / no action taken)
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Search for an existing open ticket	No open ticket? Go to HubSpot contact and create a note	Tag ticket owner in a note Urgent? Tag manager (Laura, Amy, Molly)

RESHOP & CARE NAVIGATION

Reshop Request / Enrollment Meeting Question
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Search for an existing open ticket	No ticket? Create a 'Reshop Request' escalation ticket For: enrollment meeting/benefitbay platform errors, complex care NOT for: buyer's remorse or expense concerns	Ticket will auto assign to manager for review (Laura, Amy, Molly)
Care Navigation Question – Coverage is active, having provider/Rx network issue
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Look for open support or escalation tickets. This is reserved for coverage that is still active.	Create HubSpot escalation ticket	Ticket type: 'Care Navigation', 'Claims Denial/Appeals' or ‘Claims/EOB Questions’ Urgent? Tag manager (Laura, Amy, Molly)

APPLICATIONS, PAYMENTS, & TRANSACTIONS

Autopay Question
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Look for an open 'RECON' ticket	If open: review ticket details No ticket: create new escalation ticket with ‘Autopay’ type	Tag owner Urgent? Tag manager (Brandon Lee)

Application Processing Question
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Look for an open 'App Processing' ticket	Review ticket and notes	Tag owner Urgent? Tag manager (Brandon Lee)

Transactions / Disputes / Mapping Question (NOT mismatches)
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Research ALL transaction history, HS notes/emails, change requests, open escalation tickets	Review everything before acting. See the resources above. If the ticket is open, contact the owner.	No escalation ticket: Inform Esat Yildirim or Jessica Hanson (urgent issues) via a HubSpot note
Missing Payments Question (non-medicare)
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Research ALL: BB transaction history, HS notes/emails, change requests, open escalation tickets, missing premium spreadsheet notes	⚠ Not everyone on missing report needs a payment — verify first. See the resources above.	Inform Esat Yildirim or Jessica Hanson (urgent issues) via a HubSpot note. If not resolved by end of day, tag Addison or ping Esat/Jessica in Teams.

Existing Escalation Tickets / Urgent Requests (Reinstatements/Access to Care)

STEP 1: Check First

STEP 2: Action

STEP 3: Tag / Notify

Research ALL transaction history, HS notes/emails, change requests, open escalation and support tickets

Review everything before acting. If the existing ticket is not progressing, tag the manager and owner for an update.

If open escalation ticket: tag owner, Tag manager (Bethany Carter)

No escalation ticket: Create new ticket using applicable properties. Ex: ‘access to care’ or ‘reinstatement’

Qualifying Life Events (QLE) & Special Enrollment Periods (SEP)

QLE Question
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Look for open coverage change requests and correspondence Check HS notes/emails and any App Processing ticket	Advise employers to create, or have employees create a coverage change request with documentation uploaded.	Non urgent question: Tag QLE owner / Brittany in HS contact If escalated issue: create escalation ticket — type: ‘coverage change request’
SEP Not Closed / Coverage Box Error (non-Medicare)
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Identify who handled the change request or application ticket	Review ownership and details	Tag owner in HS note Include QLE mgr (Brittany) or App mgr (Brandon)
MEDICARE
Medicare Coverage Box / SEP / Errors
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Identify who handled the ticket and the change request	Review ownership and details	Tag ticket owner in HS note Include Medicare manager (Laura / Amy / Molly)
Medicare Missing Payments / Mismatches
STEP 1: Check First	STEP 2: Action	STEP 3: Tag / Notify
Research ALL: BB transaction history, HS notes/emails, change requests, open escalation tickets, missing premium spreadsheet notes	⚠ Not everyone on missing report needs a payment — verify first. See resources above.	Tag ticket owner in HS note Urgent? Tag manager (Laura / Amy / Molly)

Ticket Guide – Escalation Ticket Types

Selecting the wrong type — especially mislabeling a Medicare issue, or stuffing a complex problem into Missing Premium — causes round-robin misrouting and slows resolution. Some types are generated automatically by the platform and should never be selected manually.

Below you will have descriptions of each ticket type. Please review the 'When to Use' column to determine the appropriate ticket type.

Escalation Type	Source	When to Use
Mismatch	Platform-generated	Do NOT manually select. Opens automatically from platform activity and closes in the platform.
Dual Enrollment	Platform-generated	Do NOT manually select. Generated by the platform when duplicate coverage is detected.
Unexpected Credit	Platform-generated	Do NOT manually select. Generated by the platform.
Medicare Mismatch	Platform-generated	Do NOT manually select. Starts and closes in the platform.
Missing Premium	Manual	Use ONLY when a premium is truly missing and just needs a one-time payment. Round-robins to Tier 1 — mislabeling complex issues here misroutes them. For complex situations, use Other.
AutoPay	Manual	Auto-pay set-up requests. Note: auto-pay may not pull until later, depending on the carrier — check before escalating.
Medicare Missing Premium	Manual	Paused — see Section 9. Document in the shared audit spreadsheet rather than creating an escalation.
Medicare Auto Pay	Manual	Manual creation for Medicare auto-pay set-up issues. Do NOT use unless a Medicare SME confirms this is the correct type.
Reinstatement	Manual (usually)	Typically manual; can come from the platform in some cases.
Coverage Change Request	Manual	Use ONLY when escalating an existing coverage change request issue. Do NOT use this type to initiate a CCR — those must start in the platform.
Access to Care	Manual	Member should have active coverage but is actively being denied care (doctor visit, prescription fill, etc.) due to a lapse in coverage or is at imminent risk of that. Always Urgent.
Care Navigation	Manual	Provider is no longer in network, continuity-of-care requests, network exception requests, and similar provider-side navigation.
Claims Denial / Appeal	Manual	Carrier has denied a claim. Help the member with the appeal process and document the path.
Claims / EOB Question	Manual	Member has an EOB they do not understand (deductible questions, why a service wasn’t covered, etc.). Investigate against the SBC.
Reshop Request	Manual	Employee believes they are entitled to re-shop due to extenuating circumstances and issue needs to be investigated. Will be reviewed by an EE Success Manager
Other	Manual	Catch-all. Routes to the pod manager for reassignment. Use when an issue spans multiple categories or doesn’t fit cleanly — include a clear description so the manager can route correctly.

Determining Urgency

Priority	Follow-up Window	When to Use
Urgent	Same day; follow up within 1–2 business days if no visible action	Reserved for true access-to-care impact or financial exposure that cannot wait: Employee/dependent cannot access a doctor, fill a prescription, or use coverage in the next few days Unexpected credit or charge actively affecting the member Coverage termination due to non-payment Data error blocking an imminent service (e.g., DOB mismatch with an appointment coming up)
High	Follow up after 3 business days if no visible action	Important but not actively blocking care; should resolve within the week (e.g., auto-pay setup where a one-time payment already cleared, time-sensitive QLE prep before a deadline).
Medium	Follow up after 5 business days of inactivity — typically resolved in ~3 weeks	Standard follow-ups, research items, and mismatches that don’t affect care. Most escalations live here: Name corrections and address updates (carrier turnaround typically 5–7 business days) Payment mismatches without access-to-care impact Claims/EOB questions, network exceptions, continuity of care

HubSpot Best Practices – Escalation Ticket Creation

Team Org Chart

Director of Assurance Services - Addison Gilliam

Payments Manager: Jessica Hanson

Esat Yildrim - Payments Coordinator

QLE Manager: Brittany Kutcher

Karla Hipolito - QLE Coordinator

Applications Manager: Brandon Lee

Dayna Campbell - Applications Coordinator
Aidan Baltz - Applications Coordinator
Bailey Miguel - Applications Coordinator
Ke'Andra Reed - Applications Coordinator

Escalations Manager: Bethany Carter

Stephanie Carey - Escalation Leads
Jessica Esteb - Escalation Leads

Overflow Contrators:

Hannah Johnson
Heidi Hill
Kimla Virden
Martin Zaragoza
Taylor Elliott

Director of Employee Success: Jessica Deines

Employee Success Manager: Molly Brown

Lisa Turner
Va'Necia Gethers
Heather Huesman
Kala Hutchinson
William Roark
Kiandra Conner

Employee Success Manager: Amy Nordquist

Lauren Jackson
Sara Brite
Katherine Correa
Iesiaah Ward
Heather Ledford
Madison Schmitt (Overflow Contractor)

Employee Success Manager: Laura Corvo

Mikayla Wheeler
Dylan Smith
Gloria Guevara
Shirley Adams

Follow-Up Cadence & Resolution Targets

Before following up on a ticket, check both the ticket and the employee’s HubSpot profile for notes — notes sometimes auto-associate to the agent contact instead of the employee, so a ticket that looks blank may have activity on the profile.

Urgent: if there is no visible action within 1–2 business days, tag the assigned manager in the ticket and ask for an update.
High: if the ticket has been stagnant for 3 business days with no notes, tag the assigned manager and ask for an update.
Medium: if the ticket has been stagnant for 5 business days with no notes, tag the assigned manager and ask for an update.
Respect carrier turnaround. If the carrier was contacted 1–3 days ago and its stated turnaround is 5–7 business days, do not follow up yet.
Tickets should not sit in “New.” Move them to In Process, Waiting on Internal Party, Waiting on External Party, or Resolution, with a note documenting the action. A ticket sitting in New with no activity is a reasonable point to tag the manager.
Non-urgent escalations: closed within ~3 weeks (mismatches and back-and-forth claims work can take longer).
Urgent escalations: same-day acknowledgement, with movement within 1–2 business days.
Set expectations with employers proactively — especially when an employee submits a request late and is pushing for a same-day fix.