Associate Director, CGA Escalations & Appeals (Remote)

Oscar-Health-; Los Angeles (CA); Remote; USD 111,000 - 162,000; Full time

Benefits offered by this job

Unlimited vacation

Benefits package

Job summary

Oscar Health is hiring an Associate Director, Appeals & Grievances to oversee non-clinical CGA operations and the Elite Member Champion Team. The role focuses on regulatory compliance, process optimization, and cross-functional collaboration with Claims, Network, Legal and Compliance.

You will lead a high-performing team across remote locations, ensuring timely resolutions and system-wide improvements while advancing a strong talent pipeline through coaching and structured management.

Qualifications

• 7+ years in healthcare operations focusing on compliance, complaints, grievances, or appeals (A&G).
• 4+ years of people management in a high-volume operations setting.
• Advanced knowledge of Commercial Insurance, Medicare/Medicaid, ACA rules for administrative CGA processes.
• Experience leading audits with CMS, state regulators, or similar bodies.
• Experience using data to lead decisions, manage capacity, and drive process improvements.
• Bachelor's degree or equivalent experience required.
• Lean Six Sigma certification or equivalent is preferred.
• Experience leading remote or multi-site teams.

Responsibilities

• Lead CGA and Escalation teams, ensuring compliance and quality across lines of business.
• Build and coach a multi-tier management and specialist team with clear accountability.
• Serve as the final authority for high-visibility administrative complaints from leadership and regulators.
• Standardize evaluation, escalation, and resolution workflows to enable end-to-end case ownership.
• Maintain audit readiness and lead CMS and state regulatory audits.
• Partner with Claims, Network, Legal, and Compliance to drive systemic root-cause solutions.
• Use workforce data and Lean methods to improve efficiency and cost-effectiveness.
• Oversee delegated vendors to meet contractual and regulatory CGA standards.
• Present performance metrics and strategic recommendations to executives.
• Ensure adherence to all applicable laws and regulations.

Skills

Leadership

Strategic thinking

Data-driven decisions

Remote team leadership

Regulatory awareness

Education

Bachelor's Degree or equivalent

MBA/MHA/JD

Tools

Tableau

Looker

Jira

Inovaare

Job description

Oscar Health is hiring an Associate Director, Appeals & Grievances to oversee non-clinical CGA operations and the Elite Member Champion Team. The role focuses on regulatory compliance, process optimization, and cross-functional collaboration with Claims, Network, Legal and Compliance.

You will lead a high-performing team across remote locations, ensuring timely resolutions and system-wide improvements while advancing a strong talent pipeline through coaching and structured management.