Remote Associate Director, Administrative CGA Escalations

Oscar Health; United States; A distancia; USD 111.000 - 162.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Unlimited vacation

Annual performance bonuses

Medical, dental, and vision benefits

Descripción de la vacante

Oscar Health is seeking an Associate Director, Appeals & Grievances & Administrative CGA to provide strategic leadership for non-clinical CGA operations, ensuring regulatory compliance and lean process excellence. You will lead high-performing teams, collaborate with cross-functional partners, and drive reductions in escalation volume while maintaining strong governance.

You will report to the Senior Director and work remotely from states where Oscar is authorized.

Formación

• 7+ years in healthcare operations focused on compliance, complaints, grievances, or appeals (A&G).
• 4+ years of people management in a high-volume operations environment.
• Advanced knowledge of Commercial Insurance, Medicare/Medicaid, and ACA rules related to CGA.
• Experience leading or representing teams during CMS/state regulatory audits.
• Experience using operational data to drive decisions, capacity planning and process improvements.
• Bachelor's degree or 4 years of equivalent experience.
• Lean Six Sigma Green/Black Belt or equivalent.
• Experience leading remote or multi-site teams in a collaborative setting.
• Experience with data visualization tools (Tableau, Looker) and case management systems (Inovaare, Jira).
• MBA/MHA/JD preferred.

Responsabilidades

• Lead CGA and Escalation teams, ensuring compliance and quality metrics across lines of business.
• Build a multi-tiered leadership team with clear performance accountability.
• Serve as the resolution authority for high-visibility administrative complaints.
• Establish standardized workflows for end-to-end case ownership.
• Maintain audit readiness and lead CMS/DOI/internal audits.
• Partner with Claims, Network, Legal, Compliance to drive systemic root-cause solutions.
• Improve efficiency using workforce data and Lean methodologies.
• Manage delegated vendors to ensure regulatory and CGA standards.
• Present metrics and strategic recommendations to executives.
• Ensure compliance with applicable laws and regulations.
• Take on other responsibilities as assigned.

Conocimientos

Healthcare operations

People management

Regulatory compliance

CMS audits

Data visualization (Tableau/Looker)

Jira

Educación

Bachelor's degree

MBA/MHA/JD

Herramientas

Inovaare

Looker

Tableau

Descripción del empleo

Oscar Health is seeking an Associate Director, Appeals & Grievances & Administrative CGA to provide strategic leadership for non-clinical CGA operations, ensuring regulatory compliance and lean process excellence. You will lead high-performing teams, collaborate with cross-functional partners, and drive reductions in escalation volume while maintaining strong governance.

You will report to the Senior Director and work remotely from states where Oscar is authorized.