Associate Director, Appeals & GrievancesPosted today$774K–$162K
The opportunity
Hi, we're Oscar. We're hiring an Associate Director, Appeals & Grievances to join our team.
What you'll do
You will lead operational goals for CGA and Escalation teams, maintaining: full accountability for compliance and quality metrics across all lines of business.
Develop a multi-tiered team of managers, lead, and specialists using: structured coaching frameworks and clear performance accountability to foster high engagement.
Be the ultimate resolution authority for high-visibility, high-risk: administrative complaints coming from senior leadership, regulatory bodies, and social channels.
Establish and enforce standardized evaluation, escalation, and resolution: workflows to ensure seamless end-to-end case ownership and eliminate friction.
Maintain constant audit readiness and act as the primary operational lead for: CMS, state Department of Insurance (DOI), and internal compliance audits.
Partner with Claims, Network, Legal, and Compliance teams to turn case data: insights into systemic root-cause solutions.
What they're looking for
- Maximize operational efficiency and cost-effectiveness by using workforce: data, capacity staffing models, and Lean methodologies.
- Manage delegated vendor entities to ensure full adherence to contractual,: regulatory, and quality CGA standards.
- Present performance metrics, operational trends, and strategic compliance: recommendations to executive leadership.
- Compliance with all applicable laws and regulations.
