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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, 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 all applicable regulations and company procedures
- Provide coaching, feedback, and recognition to direct reports; monitor performance on timely and accurate processing of complaints, grievances, and appeals
- Apply critical thinking to ensure workflows meet or exceed internal and external SLAs and turnaround times
- Leverage advanced understanding of state and federal insurance regulations to ensure accuracy of deliverables
- Identify and coordinate team member training needs based on performance and implement process improvements
- Monitor case management dashboards and error reports to ensure productivity, accuracy, and timeliness
- Manage inventory and distribute work to meet production standards
- Act as a Subject Matter Expert (SME) for your area of responsibility and liaison between CGA and other business units
- Support corrective action procedures, up to and including separation, with manager and HR oversight
- Lead projects outside daily operations to improve processes and member experience
- Report to the Associate Manager, CGA & MPCT
Occasional travel may be required for team meetings and company events, though daily work is completed from your home office.
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 or leadership experience
- Bachelor's Degree
