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Salary: USD 55,890 - 73,355 / annual
Oscar Health is seeking a CGA Team Lead to supervise day-to-day operations of the Complaints, Grievances, and Appeals (CGA) team. In this role, you will manage a team of CGA staff, provide guidance on assignments, and ensure all cases are resolved in compliance with state and federal regulatory requirements and Oscar's policies. You will oversee team performance, facilitate case resolution through problem-solving, and build partnerships across the organization to achieve departmental goals. You may also lead process improvement projects to enhance member experience.
Key responsibilities include:
- Managing day-to-day team needs to ensure compliance with Federal and State regulations and timeframes across all case types and lines of business
- Applying critical thinking to establish workflows that meet or exceed internal and external SLAs and turnaround times
- Delivering coaching, feedback, and recognition to direct reports
- Leveraging advanced understanding of state and federal regulations to ensure accuracy of case deliverables
- Monitoring direct report performance on timely and accurate processing of complaints, grievances, and appeals, including attendance and job-related behavior
- Identifying and coordinating team training needs based on performance and trends; implementing process improvements as needed
- Being accountable for team metrics and compliance
- Monitoring case management dashboards and error reports to ensure productivity, accuracy, and timeliness
- Providing regular performance feedback and supporting corrective action procedures, including separation when necessary, with manager and HR oversight
- Managing inventory and distributing work to meet production standards and turnaround times
- Answering internal and external customer questions and assisting peers and management
- Acting as a liaison between CGA and other business units regarding CGA processes
- Serving as a Subject Matter Expert (SME) for assigned areas
- Making recommendations and leading process improvements
- Ensuring compliance with all applicable laws and regulations
This is a remote position open to candidates residing in Arizona, Florida, Georgia, or Texas. Occasional travel may be required for team meetings and company events. You will report to the Associate Manager, CGA & MPCT.
Requirements:
- 3+ years of relevant experience directly related to this role
- 2+ years of experience with and equivalent knowledge of Commercial Insurance, Medicare/Medicaid, and/or Affordable Care Act rules and regulations relating to Grievance & Appeals processes
- 1+ years of experience with or relevant knowledge of navigating Google Docs and Sheets
Bonus qualifications:
- Experience with state-level audits
- Management/leadership experience
- Bachelor's Degree
