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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 Complaint, Grievances and Appeals (CGA) team. In this role, you will manage a team of CGA staff, providing guidance on assignments and ensuring they meet performance expectations while maintaining compliance with state and federal regulatory requirements and Oscar's policies.
Key responsibilities include:
- Supervise daily CGA production operations and ensure cases are resolved in accordance with regulatory requirements
- Provide coaching, feedback, and recognition to direct reports
- Monitor team performance metrics, case accuracy, timeliness, and compliance
- Review case management dashboards and error reports to ensure productivity
- Identify training needs and implement process improvements based on team trends
- Manage work distribution to meet production standards and turnaround times
- Act as a Subject Matter Expert (SME) for assigned areas
- Lead cross-functional partnerships to facilitate case resolution
- Support corrective action procedures with manager and HR oversight
- Lead projects to improve processes and member experience
- Answer internal and external customer questions and assist peers and management
You will report to the Associate Manager, CGA & MPCT. While work is completed remotely from your home office, occasional travel may be required for team meetings and company events.
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
