Hi, we're Oscar. We're hiring an Associate, Claims Issue Resolution & Audit Support to join our Claims Operations team.
Oscar is the first health insurance company built around a full stack technology platform and a 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, Claims Issue Resolution & Audit Support is responsible for supporting audit activities, both internal and external for claims operations. They are the subject matter expert for their team and a key member for claims and benefits knowledge. The Associate provides support to the business and the Associate Director relative to audit research, information and fact gathering, as well as comprehensive root cause analysis and identifying solutions.
You will report to the Associate Director, Claims Issue Resolution.
Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.
If you live within commutable distance to our New York City office ( in Hudson Square), our Tempe office (off the 101 at University Ave), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.
You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote
Pay Transparency:
The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $93,600 - $122,850 per year. The base pay for this role in all other locations is: $84,240 - $110,565 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.
Responsibilities
- Provide subject matter expertise and in-depth understanding of Claims processing workflows.
- Identify claims payment issues that require action and provide action steps needed to remediate the issue.
- Identify all claims with similar payment issues and Identification of claims paid incorrectly and manage the process to recover the incorrect payments and any adjoining configuration updates.
- Represent claims in payment policy discussions and when necessary, document new policies or modifications to existing policies.
- Provide training and education to team members when necessary.
- Act as a subject matter expert using internal and external tools in order to complete audits and provide guidance to team members.
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- 3+ years of experience in claims processing, auditing and managed care operations
- 2+ year(s) ability to work independently to drive projects to completion
Bonus Points
- Bachelor’s degree
- CPC or Medical Claims Coding Certification
- Experience with state and federal regulation agencies (e.g. CMS, DOI, etc.)
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraudhere.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives..
Pay Transparency:
Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience.
Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Reasonable Accommodation:
Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.