Appeals & Grievances Director

Hi, we're Oscar. We're hiring an Associate Director, Appeals & Grievances to join our team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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 Associate Director, Escalations — Administrative Complaints, Grievances & Appeals (CGA) provides strategic leadership and operational oversight for Oscar's non-clinical Administrative CGA and Elite Member Champion Team (MCT) operations. This role is responsible for driving operational excellence and regulatory compliance across all lines of business, and utilizes Lean methodologies and capacity-based staffing models to maintain strict adherence to federal (CMS) and state turnaround times. The Associate Director, Escalations — Administrative CGA will lead high-performing teams through complex administrative member and provider issue resolutions, leverage case data to mitigate reputational risk, and collaborate with cross-functional partners in Claims, Network, Legal, and Compliance to eliminate root causes and proactively reduce overall escalation volume while fostering a strong talent pipeline.

You will report into the Senior Director Member & Provider Programs.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; California, Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $ 123,372.00- $161,925.75 per year. The base pay for this role in all other locations is: $111,034.80- $145,733.18 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• 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.