CGA Triage Coordinator

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