CGA Team Lead

Oscar Health; Atlanta (GA); On-site; USD 56,000 - 73,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

11 paid holidays

Paid sick time

Paid parental leave

Wellness time reimbursements

Job summary

Oscar Health is seeking a CGA Team Lead to supervise daily CGA production operations and guide staff to meet performance targets. You will ensure regulatory compliance and collaborate across the organization to improve member experience.

The role reports to the Associate Manager, CGA & MPCT, and may involve projects outside daily operations. Remote work is available for eligible states with occasional travel for meetings and events.

Qualifications

• 3+ years of relevant experience in CGA or similar roles.
• 2+ years knowledge of Commercial Insurance, Medicare/Medicaid and/or ACA rules.
• 1+ years experience using Google Docs and Sheets.

Responsibilities

• Manage day-to-day CGA production operations and staff.
• Provide coaching, feedback, and recognition to direct reports.
• Ensure compliance with federal and state regulations and Oscar policies.
• Lead process improvements and partner with cross-functional teams.
• Monitor team performance and production metrics.

Skills

Regulatory compliance

Team leadership

Coaching & feedback

Google Docs/Sheets

Education

Bachelor's degree

Tools

Google Docs

Google Sheets

Job description

Hi, we're Oscar. We're hiring a CGA Team Lead to join our Complaint, Grievances and Appeals team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

As a CGA Team Lead, you will supervise the day-to-day CGA production operations. You will provide guidance to the CGA staff on their assignments while leading them to meet performance expectations. You will ensure that cases are resolved in accordance with state and federal regulatory requirements and Oscar's policies and procedures. You will provide oversight to your immediate team and the broader CGA Team to achieve departmental goals. You will be responsible for facilitating the resolution process through problem-solving and creating strong partnerships across the organization. You may also lead projects outside the daily production operation to improve processes and the member experience.

You will report into the Associate Manager, CGA & MPCT .

Work Location

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency

The base pay for this role is: $55,890- $73,355 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• The CGA Team Lead is responsible for managing the day to day needs of the team to ensure compliance with Federal and State regulations and timeframes on all case types and lines of business
• Apply critical thinking to ensure proper workflows are in place to meet/exceed internal and external SLAs and TATs
• Deliver coaching, feedback and recognition as warranted to support direct reports
• Leverage advanced understanding of state and federal regulations to ensure accuracy of deliverables/cases
• Monitor performance for direct reports for timely and accurate processing of complaints, grievances, appeals, attendance, schedules, and other job related behavior
• Identify and coordinate team member training needs based on performance, as well as team trends that may require implementing process improvements
• Be accountable for team metrics and compliance
• Manage day-to-day needs of your team
• Monitor and review case management dashboards and error reports to ensure productivity and case accuracy and timeliness
• Give direct reports regular feedback on performance and help support corrective action procedures, up to and including separation, with manager and HR oversight when needed
• Perform inventory management and ensure that work is distributed appropriately in order to meet defined production standards and turn-around times
• Answer internal and external customer questions, assists peers and Manager or Associate Director with tasks
• Act as a liaison between CGA and other business units, as needed and in partnership with CGA management, as it pertains to CGA processes
• Act as a Subject Matter Expert (SME) for area(s) of responsibility
• Make recommendations and help lead process improvements as needs are identified
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements

• 3+ years of relevant experience directly related to this role
• 2+ years experience with and equivalent knowledge of Commercial Insurance, Medicare/Medicaid and/or Affordable Care Act rules and regulations relating to the Grievance & Appeals processes
• 1+ years experience with or relevant knowledge of navigating Google Docs and Sheets

Bonus points

• Experience with any state-level audit
• Management/leadership experience
• Bachelor's Degree

This is an authentic Oscar Health job opportunity.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

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Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) to make the need for an accommodation known.

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