CGA Team Lead
Oscar Health
Salary undisclosed
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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.
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.
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 (accommodations@hioscar.com) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.
Benefits
- health insurance
- 401(k)
- parental leave
- disability insurance
- sick leave
About this role
Oscar Health is looking for a CGA Team Lead to manage day-to-day operations for their Complaint, Grievances and Appeals team. You'd supervise a team handling member cases while ensuring compliance with state and federal regulations, monitoring performance metrics, and coaching staff toward departmental goals. The role requires deep knowledge of commercial insurance, Medicare/Medicaid, and ACA rules as they apply to grievance and appeals processes—you'll use that expertise to review cases, identify workflow gaps, and partner across the organization to resolve issues and improve processes.
This position suits someone with at least three years of directly relevant experience and two years working with health insurance regulations in this space. You'll need strong judgment to apply critical thinking to case workflows, comfort with Google Docs and Sheets, and the ability to deliver feedback and manage performance conversations, including difficult ones. A bachelor's degree is expected, and prior management experience or exposure to state-level audits would strengthen your candidacy.
The role is fully remote for residents of Arizona, Florida, Georgia, or Texas, with occasional travel for team meetings. Base pay ranges from $55,890 to $73,355 annually, plus performance bonuses, unlimited vacation, and standard health benefits. You'd report to an Associate Manager and have room to lead process improvement projects beyond day-to-day operations.
How this employer is doing
solid
- Financial News
- Expanding
In the news
Oscar Health Plans Major Obamacare Expansion Over Next Three Years, Forbes
This role's local market on JobMinglr
Pay for this role
The employer didn't post a pay range for this role. That usually means pay is set in negotiation, which favors whoever arrives with numbers. Check ranges on comparable CGA Team Lead postings in Atlanta, and analyze any offer before you accept it.
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