layiq

/la·yiq/adjective

worthy; deserving; fitting; suitable.

A role, opportunity, or path that merits attention, time, and pursuit.

LAYIQ - CGA Team Lead at Oscar Health, Dallas, TX

Responsibilities:

The CGA Team Lead is responsible for managing the day to day needs of the team to ensure compliance with Federal and State regulations and timeframes on all case types and lines of business
Apply critical thinking to ensure proper workflows are in place to meet/exceed internal and external SLAs and TATs
Deliver coaching, feedback and recognition as warranted to support direct reports
Leverage advanced understanding of state and federal regulations to ensure accuracy of deliverables/cases
Monitor performance for direct reports for timely and accurate processing of complaints, grievances, appeals, attendance, schedules, and other job related behavior
Identify and coordinate team member training needs based on performance, as well as team trends that may require implementing process improvements
Be accountable for team metrics and compliance
Manage day-to-day needs of your team
Monitor and review case management dashboards and error reports to ensure productivity and case accuracy and timeliness
Give direct reports regular feedback on performance and help support corrective action procedures, up to and including separation, with manager and HR oversight when needed
Perform inventory management and ensure that work is distributed appropriately in order to meet defined production standards and turn-around times
Answer internal and external customer questions, assists peers and Manager or Associate Director with tasks
Act as a liaison between CGA and other business units, as needed and in partnership with CGA management, as it pertains to CGA processes
Act as a Subject Matter Expert (SME) for area(s) of responsibility
Make recommendations and help lead process improvements as needs are identified
Compliance with all applicable laws and regulations
Other duties as assigned

Requirements:

3+ years of relevant experience directly related to this role
2+ years experience with and equivalent knowledge of Commercial Insurance, Medicare/Medicaid and/or Affordable Care Act rules and regulations relating to the Grievance & Appeals processes
1+ years experience with or relevant knowledge of navigating Google Docs and Sheets
Bonus points: Experience with any state-level audit
Management/leadership experience
Bachelor's Degree
This is an authentic Oscar Health job opportunity.
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.

CGA Team Lead

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