Complaints Grievances & Appeals Intake Coordinator

Job Description

Hi, we're Oscar. We’re hiring an Intake Coordinator to join our Complaints Grievances and Appeals team in our Tempe office.

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:

As an Intake Coordinator, you are responsible for the beginning-to-end process of receiving and ensuring appropriate and timely setup of new member and regulator cases. You will correctly identify case type (grievance/complaint/appeal) while completing all field values within tickets accurately, processing them according to state and federal requirements. Additionally, you will ensure member cases are acknowledged via written letter within the service level standards determined by CGA Leadership, and manage incoming email communications regarding new or existing regulator cases.

You will report to the CGA 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:

• Communicate in writing via acknowledgement letter to members regarding the receipt of their case
• Managing cases to meet internal and external state regulations
• Assign cases to Liaison 1’s utilizing the rotation spreadsheet.
• Work collaboratively and cross-functionally with your teammates.
• Correctly identify standard, exempt, void, and duplicate tickets in JIRA.
• Manage incoming email communications from regulators regarding new or existing regulator cases, ensure new cases are created and assigned, and properly update existing cases in JIRA, as necessary.

Requirements:

• 1+ year of relevant experience in Healthcare Industry i.e Compliance, Complaints, Grievances & Appeals, and/or Quality
• Bachelor's Degree or 3 years of relevant experience

Bonus points:

• Knowledge of State regulations in relation to the grievance and appeals process

Life at Oscar:

Our more than 1,000 employees aim to make health care affordable and accessible for all. We 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.

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 your unique background and perspectives.

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.

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 .

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 ([email protected]) 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 .

COVID-19 vaccine requirements for in-person work:

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 [email protected] 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.