Complaints, Grievances and Appeal Manager - Remote
Hi, we're Oscar. We're hiring a Complaints, Grievances and Appeals Manager - Medicare Advantage to join our Complaints, Grievances and Appeals Operations team.
Oscar is the first health insurance company built around a full stack technology platform and a 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 the Complaints, Grievances and Appeals (CG&A) Manager, you will manage a team working every aspect of CTMs, Grievances and Appeals on behalf of +Oscar's Medicare Advantage members in the delivery and adherence to CMS guidance.
You will represent and speak on behalf of Oscar in interactions with Oscar delegates, CMS, auditors and clients identifying and reporting issues working across Oscar teams to guide action.
You will report to the CGA Senior Manager. This is a remote role, you will work remotely in one of the following states: Arizona, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.
- Manage the daily success and operations of the team, including KPI results
- Provide ongoing career development for the team along with the encouraging Oscar's culture to promote employee engagement and satisfaction
- Manage people-related decisions, including attendance, behavioral coaching conversations, and performance management outcomes
- Operationalize regulatory requirements including setting system specs, revising policies and procedures based on regulatory scheme, implementing policies and procedures while building the team
- Ensure your team has the tools, resources, knowledge and support to meet their goals
- Establish monitoring and oversight processes to ensure we're compliant including working with vendors that support our business
- Be the primary expert and voice for all Medicare Advantage grievances and appeals
- Be the primary Member voice and interface for regulatory entities across all markets.
- Ensure your team is hitting Service level agreements and addressing grievances and appeals for Medicare Advantage members within required time frames as outlined by federal regulatory agencies
- Partner with team members to ensure processes are continuously refined and improved with an ultimate goal of an enhanced member/provider experience
- Develop and implement new strategic plans
- Measure results, make recommendations and improve upon service delivery
- Work in an agile manner to prioritize issues and manage expectations with regulatory entities and team members.
- Scaling processes and improving efficiency while enhancing the member experience will be a top priority
- 5+ years of experience managing teams
- 5+ years developing teams
- 2+ years Healthcare experience; specifically with Medicare Grievances & Appeals
- 2+ years managing relationships with regulatory bodies including CMS & NCQA
- Knowledge of and coaching on audit protocols and reporting requirements, adherence to policies and procedures, as project efforts, such as business requirement documents, process flows, and business continuity plans specific to your team's processes.
- 4 year degree or commensurate experience
- Experience working with teams in multiple locations
- Prior audit experience
Life at Oscar
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.
We encourage our members to care for their whole selves, and we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.
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 (email@example.com) to make the need for an accommodation known.
Pay Transparency Policy
Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.
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