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Oscar Health // health insurance
 
Media, Full Time    Tempe, Arizona, United States    Posted: Tuesday, August 31, 2021
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring an Editor to join our Complaints, Grievances & Appeals (CGA) Medicare team. 

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 & headquartered in New York City. Our goal is to make health insurance simple, transparent, & human. We need your help to do so.

The Oscar Complaints, Grievance & Appeals Department plays an important role at Oscar.  We are responsible for responding to complaints from our members according to state & federal requirements.  We are Powered by People who have a passion for refactoring healthcare & are committed to Seek the Truth & to Make it Right.  

As a CGA Editor, you will be responsible for the beginning-to-end process of editing all outbound member response letters. You will ensure the language utilized in outbound member letters is clear, professional, grammatically correct, & aligns with both state & federal regulatory requirements, as well as Oscars policies & procedures. Your review of the letter will include verifying that all elements of the case have been addressed & that education & resources have been provided to assist the member in the future, if necessary. In addition, you will consistently provide feedback to team members regarding the quality of their member response letters, including any coaching opportunities, as necessary.

 

You will report into the Team Lead of Complaints Grievances & Appeals. This is a remote role, you will work remotely in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.

Responsibilities:

  • Ensure member response letters are reviewed, edited & sent back to team members within set state regulatory time frames
  • Evaluate member response letters for content, clarity, accuracy, & consistency
  • Meet daily & weekly production goals
  • Work as a team to complete departmental tasks to meet deadlines & accomplish department objectives. This may include evenings, weekends and/or holidays.

 

Requirements

  • High school degree or equivalent
  • Minimum one year of relevant previous experience in Appeals & Grievances, Utilization Management, or Member Services for a health plan or medical group
  • Knowledge of insurance industry & applicable state & federal laws
  • Advanced business writing & verbal communication skills
  • Employee is performing at expectations in his/her current role as evidenced by at least a Meets Expectations on most recent review 
 
 
 
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