CGA Team Lead

Oscar; Dallas (TX); Remote; USD 56,000 - 73,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

11 paid holidays

Paid sick time

Paid parental leave

401(k)

Life and disability insurance

Paid wellness time

Job summary

Oscar is seeking a CGA Team Lead to supervise day-to-day production operations and guide the CGA staff to meet performance goals. You will ensure cases comply with state and federal regulations and Oscar policies, while overseeing the team and cross-functional partnerships.

The role reports to the Associate Manager, CGA & MPCT. This is a remote position open to several states with occasional travel for meetings and events. Eligible for benefits and performance bonuses.

Qualifications

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

Responsibilities

• Manage day-to-day CGA production operations and ensure regulatory compliance.
• Provide coaching, feedback and recognition to direct reports.
• Lead process improvements to enhance member experience and reduce SLAs and TATs.
• Monitor team metrics and review case management dashboards for accuracy and timeliness.
• Collaborate with CGA management and other units to optimize CGA processes.

Skills

Regulatory knowledge

Leadership

Google Docs/Sheets

Communication

Education

Bachelor's Degree

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.

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.

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.

Equal 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.

Artificial Intelligence (AI)

Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation

Oscar applicants are considered solely based on their qualific