[Hiring] CGA Team Lead @Oscar Health

Role Description

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

• Manage 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.

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.

Bonus Points

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

Benefits

• Medical, dental, and vision benefits.
• 11 paid holidays.
• Paid sick time.
• Paid parental leave.
• 401(k) plan participation.
• Life and disability insurance.
• Paid wellness time and reimbursements.