CGA Triage Coordinator

Oscar Health•Dallas, TX

7d•$22•Remote

About The Position

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.

Requirements

1+ years of customer support/service experience
Excellent organizational and time management skills
Foundational knowledge of escalations or complaints, grievances and appeals processes

Nice To Haves

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

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