Associate Director, Appeals & Grievances
Core
Provide strategic leadership and operational oversight for Oscar's non-clinical Administrative Complaints, Grievances & Appeals (CGA) and Elite Member Champion Team operations, ensuring regulatory compliance and operational excellence.
Role type
Senior IC operations leader (healthcare compliance & appeals)
Builds
High-performing teams and standardized resolution workflows for administrative member and provider issues
Domain
Health insurance / Healthcare compliance
Required skills
Healthcare operations leadership, regulatory compliance (CMS, ACA, Medicare/Medicaid), team management, process improvement (Lean), data-driven decision making, vendor management, audit readiness
Preferred skills
Lean Six Sigma certification, data visualization (Tableau, Looker), case management systems (Inovaare, Jira), MBA/MHA/JD
Technologies
CMS systems, Lean methodologies, Tableau, Looker, Inovaare, Jira
Responsibilities
Lead operational goals for CGA teams, develop multi-tiered management teams, resolve high-risk administrative complaints, enforce standardized workflows, maintain audit readiness, partner with Claims/Legal/Compliance for root-cause solutions, manage vendor entities, present metrics to executive leadership
Seniority
Senior, hands-on IC with people management
