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Oscar Health

Medicare Advantage Program Manager Complaints Grievances & Appeals

Payson, AZ

Hi, we're Oscar. We’re hiring a Medicare Advantage Program Manager to join our Complaints Grievances & Appeals 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:

The Complaints Grievances & Appeals (CG&A) Program Manager supports the compliant delivery of Medicare Advantage Grievances and Appeals requirements as defined by the Centers for Medicare and Medicaid Services (CMS). In this role, the Program Manager will be accountable for continuous monitoring of the work in progress to ensure correct classification and handling by the processing team. You are responsible for providing feedback and coaching to the individual processors and validating that corrections are made. You will document and track monitoring activity highlighting patterns and trends and report your findings including  recommendations and actions taken to close operational gaps to the leadership team. 

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As part of closing operational gaps and supporting team success, you will be responsible for developing and maintaining procedural documentation for the department. You will serve as the subject matter expert and partner with the Learning & Development team to develop materials and content. You will communicate new or updated procedures to the team for awareness and reinforcement of knowledge. 

 

You will report into the CG&A Manager. This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change. #LI-Remote

 

Responsibilities:

  • Perform routine monitoring of casework to ensure accurate classification and processing of cases 
  • Manage, track and report risks from monitoring activities to Leadership
  • Implement solutions based on findings and insights
  • Develop or improve existing procedures to provide clarity on case processing 
  • Collaborate with the Knowledge Management team to design layout and organization of content in the knowledge management system 
  • Partner with Learning & Development to design or improve the onboarding program and supplemental training modules
  • Identify gaps in department knowledge in order to create, iterate, and launch trainings
  • Work cross functionally to support new hire onboarding - from system access to orientation and team introductions
  • Facilitate onboarding or refresher courses 
  • Support new hire transition from training to production 
  • Develop and sustain effective and professional working relationships with peers, leaders, and internal and external stakeholders.
  • Work as a team to complete departmental tasks to meet deadlines and accomplish department objectives. This may include evenings, weekends and/or holidays.

Requirements:

  • Bachelor’s degree or 4+ years of equivalent work experience
  • 3+ years of work experience in health insurance, grievances and appeals, and/or operations
  • 3+ years of experience in Medicare Advantage
  • Strong communication and analytical skills
  • Experience / background in a fast-paced operations environment
  • Experience in delivering projects / programs independently and within a team environment

 

Bonus points:

  • Experience with CMS Program Audits or any state-level audit
  • Operational compliance 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 aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

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 (accommodations@hioscar.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.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here

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, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

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.

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 (accommodations@hioscar.com) to make the need for an accommodation known.

To protect the health and 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 accommodations@hioscar.com to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices, employees conducting sales work in the field and employees conducting at-home or in-person visits with members.

Client-provided location(s): Arizona, USA
Job ID: 4257566
Employment Type: Other

Perks and Benefits

  • Health and Wellness

    • Pet Insurance
    • Mental Health Benefits
    • FSA
    • HSA
    • Fitness Subsidies
    • Health Insurance
    • Dental Insurance
    • Vision Insurance
    • Life Insurance
    • Short-Term Disability
    • Long-Term Disability
  • Parental Benefits

    • Adoption Leave
    • Fertility Benefits
    • Family Support Resources
    • Non-Birth Parent or Paternity Leave
    • Birth Parent or Maternity Leave
  • Work Flexibility

    • Remote Work Opportunities
    • Flexible Work Hours
    • Hybrid Work Opportunities
  • Office Life and Perks

    • Happy Hours
    • Commuter Benefits Program
    • Casual Dress
  • Vacation and Time Off

    • Personal/Sick Days
    • Paid Holidays
    • Paid Vacation
  • Financial and Retirement

    • Company Equity
    • Performance Bonus
    • Financial Counseling
    • 401(K) With Company Matching
  • Professional Development

    • Internship Program
    • Leadership Training Program
    • Access to Online Courses
    • Mentor Program
  • Diversity and Inclusion

    • Employee Resource Groups (ERG)
    • Diversity, Equity, and Inclusion Program

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