Remote CGA Team Lead, Grievances & Appeals

Oscar Health; United States; Remote; USD 56,000 - 73,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

Unlimited vacation program

Annual performance bonuses

Job summary

Oscar Health is seeking a CGA Team Lead to supervise the Complaint, Grievances and Appeals production operations. You will guide a CGA staff, ensure regulatory compliance, and drive improvements in member experience from your home office.

You will report to the Associate Manager, CGA & MPCT. This remote role is open to Arizona, Florida, Georgia, or Texas residents with potential travel for team meetings and events.

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 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

Responsibilities

• Manage the day-to-day needs of the CGA 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 to meet internal SLAs and TATs.
• Provide coaching, feedback and recognition to support direct reports.
• Leverage understanding of state and federal regulations to ensure accuracy of deliverables.
• Monitor performance for direct reports and manage attendance, schedules and other job-related behavior.
• Identify training needs and implement process improvements based on performance trends.
• Be accountable for team metrics and compliance.
• Coordinate with CGA and other units to optimize processes and member experience.

Skills

Team leadership

Regulatory knowledge

Problem solving

Education

Bachelor's Degree

Tools

Google Docs

Google Sheets

Job description

Oscar Health is seeking a CGA Team Lead to supervise the Complaint, Grievances and Appeals production operations. You will guide a CGA staff, ensure regulatory compliance, and drive improvements in member experience from your home office.

You will report to the Associate Manager, CGA & MPCT. This remote role is open to Arizona, Florida, Georgia, or Texas residents with potential travel for team meetings and events.