Complaints Grievances Appeals Liaison Medicare Advantage (Remote)

Hi, we're Oscar. We’re hiring a Complaints Grievances and Appeals (CGA) Liaison to join our Clinical team in our Tempe office. 

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

About the role:

As a Complaints Grievances and Appeals Liaison, you will be responsible for the beginning-to-end process of receiving, researching and resolving new and existing member grievance cases. This includes any escalated requests in the grievance process, in accordance with state and federal regulatory requirements, and Oscar policies and procedures.

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

Responsibilities:

Perform initial analysis of cases to determine next steps and/or escalation pathway(s)

Perform complete and consistent documentation of escalation pathway(s), research and communications in JIRA

Communicate with providers and/or members regarding their cases within required regulatory timeframes

Make outbound calls to providers and/or members regarding your cases, as necessary, to aid in your research and resolution process

Work collaboratively and cross-functionally with other departments in JIRA, email, or in person to facilitate appropriate resolutions t

Work as a team to complete departmental tasks to meet deadlines and accomplish department objectives. This may include evenings, weekends and holidays.

Resolve a minimum of 18 cases weekly

Maintain a quality score average of 90%

Maintain a 99% compliance rate for your response turnaround times 

Develop effective and professional working relationships with internal and external stakeholders

Identify operational issues and trends observed from the management of your cases, and communicate these issues to the CGA Leadership

Assist CGA Leadership and peers with special projects, and complete projects within the proposed deadline(s), set by management

Attend and actively participate in team meetings, operational meetings, trainings and coaching sessions

Requirements:

1+ year of relevant experience in Healthcare industry (i.e. Compliance, Complaints, Grievances and Appeals, Quality or Project Management) 

1+ year of experience writing in a professional setting

Bonus points:

Bachelor's Degree 

Strong proficiency navigating and working in multi-system environment (customer service, case management, claims) 

Medicare Advantage

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 aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: medical benefits, unlimited paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.