CGA Team Lead

Oscar Health; Phoenix (AZ); Remote; USD 56.000 - 73.000; Vollzeit

Zusammenfassung

Oscar Health seeks a CGA Team Lead to supervise day-to-day production operations within the Complaint, Grievances and Appeals team. You will guide staff, ensure cases meet regulatory requirements, and collaborate across the organization to improve member experience.

Reporting to the Associate Manager, CGA & MPCT, you will drive process improvements, manage performance, and support the team in meeting SLAs and TATs while working remotely from home offices in the U.S.

Qualifikationen

• 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 the Grievance & Appeals processes.
• 1+ years experience with or relevant knowledge of navigating Google Docs and Sheets.
• Management/leadership experience.

Aufgaben

• Manage the day-to-day CGA production operations to ensure compliance with Federal and State regulations and timeframes on all case types.
• Provide coaching, feedback and recognition to direct reports as warranted.
• Monitor performance for direct reports for timely and accurate processing of complaints, grievances, and appeals.
• Identify and coordinate team member training needs based on performance and trends; drive process improvements.
• Act as SME for CGA areas and liaise with other units as needed; ensure compliance with laws and Oscar policies.
• Manage inventory and ensure work is evenly distributed to meet production standards.

Kenntnisse

Leadership

Team management

Regulatory knowledge

Problem-solving

Ausbildung

Bachelor's Degree

Tools

Google Docs

Google Sheets

Jobbeschreibung

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.

Equality and Inclusion

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.

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 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 () to make the need for an accommodation known.

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