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We're hiring a CGA Triage Coordinator to join our CG&A 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:
(You will play a critical role in the initial management and routing of all member complaints, grievances and appeals. You will be responsible for the timely and accurate intake, categorization, and prioritization of incoming cases. By ensuring that each case is promptly triaged and assigned to the appropriate liaison, the Coordinator directly supports the team's ability to meet strict regulatory deadlines and maintain the highest standards of member and provider service.
You will report into the CGA Team Lead.
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: $22.00 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.
Responsibilities:
- Receive, log, and process all incoming complaints, grievances, and appeals through various channels, including mail, fax, email, and internal systems.
- Monitor and manage case queues, proactively flagging urgent cases and assigning them to the appropriate liaison or team.
- Identify, investigate, and triage incoming documents within determined SLAs
- Collaborate with colleagues, specialists, and Leads to identify trends and roadblocks
- Utilize internal tools and resources seamlessly
- Escalate updates or incorrect information in the internal knowledge management system for Member and Provider Services
- Compliance with all applicable laws and regulations
- Other duties as assigned
Requirements:
- 1+ years of customer support/service experience
- Excellent organizational and time management skills
- Foundational knowledge of escalations or complaints, grievances and appeals processes
Bonus points:
- Experience in a Complaints, Grievances or Appeals department
- Experience using CRM and knowledge management tools to resolve issues
- Experience using ticket management and reporting tools
- Experience managing an assignment caseload
- Healthcare and/or SAAS experience
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
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 ([email protected]) 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 .
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