CGA Team Lead
Core
Supervise daily operations of the Complaint, Grievances, and Appeals (CGA) team to ensure regulatory compliance and case resolution.
Role type
Team Lead for Complaint, Grievances, and Appeals operations
Builds
Resolved member complaints, grievances, and appeals cases
Domain
Health Insurance / Regulatory Compliance
Deliverable
client delivery
Required skills
Team supervision, State and federal insurance regulations, Commercial Insurance, Medicare/Medicaid, ACA rules, Process improvement, Performance monitoring, Inventory management
Preferred skills
State-level audit experience, Management/leadership experience
Technologies
Google Docs, Google Sheets
Responsibilities
Supervise day-to-day CGA production operations, Ensure cases are resolved in accordance with state and federal regulatory requirements, Provide guidance to CGA staff on assignments, Monitor performance for direct reports, Identify and coordinate team member training needs, Manage day-to-day needs of the team, Monitor and review case management dashboards, Act as a Subject Matter Expert (SME), Lead process improvements
Seniority
Mid-level, hands-on IC with team leadership