Director of Complaints, Grievances and Appeals Optimization

Job Description

Hi, we're Oscar. We're hiring a Director of Complaints, Grievances and Appeals Optimization to join our Concierge Optimization team.

Oscar is the first health insurance company built around a full stack technology platform and a 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 Director of Complaints, Grievances and Appeals Optimization will develop the department's strategy, managing its resources, developing and implementing an operating plan for improving efficiency, scaling operations and ensuring the achievement of departmental performance metrics while ensuring compliance.

You will report to the Senior Director, Strategy and Optimization. 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:

• Lead, coach and develop a high-performing team of managers and their reports
• Provide structure and support for your team, allowing them to keep their focus on delivering key initiatives
• Develop foundational processes for scaling our complaints, grievances and appeals operations
• Lead team to surface data, process, and technology issues through proactive identification, measurement, and monitoring of our operations; partner to develop end-to-end strategy that uses these insights to grow
• Oversee team vision and strategy including quarterly vital setting and multi-year roadmap
• Be a transformation champion across the business while serving as an expert
• Manage, develop and maintain relationships to lead multi department collaboration
• Drive a data-driven approach to identify trends and process variations which includes performing cost benefit analysis to support transformational projects
• Work with other management areas to ensure operational consistency within the organization and all lines of business.
• Promote the use of accepted best practices and innovative strategies.
• Ensure operational compliance with all relevant regulatory agencies.
• Ensure operations meet vendor/customer contractual requirements.

Requirements:

• A bachelor's degree or commensurate 4 years of experience
• 10+ years of work experience in health insurance, consulting, healthcare or operations
• 5+ years of experience leading and developing a team
• 4+ years experience working in payer complaints, grievances and appeals
• Experience with Medicare Advantage
• Experience in program management, program design or implementation
• Experienced success for improving processes and workflows including workflow design and working with product/engineering teams to design tooling

Bonus points:

• Lean / Six Sigma experience
• Experience working in a startup environment where leaders are required to operate lean teams and zoom in and out to succeed

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.

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.

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.