Hi, we're Oscar. We're hiring a Complaints, Grievances & Appeals Manager - Medicare Advantage to join our Complaints, Grievances & Appeals Operations team.
Oscar is the first health insurance company built around a full stack technology platform & a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.
About the role
As the Complaints, Grievances & Appeals (CG&A) Manager, you will manage a team working every aspect of CTMs, Grievances & Appeals on behalf of +Oscar's Medicare Advantage members in the delivery & adherence to CMS guidance.
You will represent & speak on behalf of Oscar in interactions with Oscar delegates, CMS, auditors & clients identifying & 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, Michigan, New Mexico, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.
- Manage the daily success & 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 & satisfaction
- Manage people-related decisions, including attendance, behavioral coaching conversations, & performance management outcomes
- Operationalize regulatory requirements including setting system specs, revising policies & procedures based on regulatory scheme, implementing policies & procedures while building the team
- Ensure your team has the tools, resources, knowledge & support to meet their goals
- Establish monitoring & oversight processes to ensure we're compliant including working with vendors that support our business
- Be the primary expert & voice for all Medicare Advantage grievances & appeals
- Be the primary Member voice & interface for regulatory entities across all markets.
- Ensure your team is hitting Service level agreements & addressing grievances & 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 & improved with an ultimate goal of an enhanced member/provider experience
- Develop & implement new strategic plans
- Measure results, make recommendations & improve upon service delivery
- Work in an agile manner to prioritize issues & manage expectations with regulatory entities & team members.
- Scaling processes & 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 Advantage Grievances & Appeals
- 2+ years managing relationships with regulatory bodies including CMS & NCQA
- Knowledge of & coaching on audit protocols & reporting requirements, adherence to policies & procedures, as project efforts, such as business requirement documents, process flows, & 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 & find both belonging & support. We're on a mission to change health care -- an experience made whole by our unique backgrounds & perspectives.
We encourage our members to care for their whole selves, & 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, & 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.
COVID-19 vaccine requirements for in-person work:
To protect the health & safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date.
If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at firstname.lastname@example.org to submit an accommodations request.
*Note: In-person work includes: employees required to work from our offices (either full-time or part-time), employees conducting sales work in the field & employees conducting at-home or in-person visits with members.