Hi, we're Oscar. We're hiring an Associate Director, Claims Issue Resolution to join our Claims 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 Director, Claims coordinates and manages activities related to the designated claims operational unit. The Associate Director, Claims directs the planning, design, development, documentation, implementation and evaluation of policies and procedures that assure accurate, timely claims processing and issue resolution. The Associate Director, Claims partners across both Insurance Operations and cross-functionally to move ideas from vision to implementation.
You will report to the Senior Director, Claims.
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.
Pay Transparency:
The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $144,000 - $189,000 per year. The base pay for this role in all other locations is: $129,600 - $170,100 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.
Responsibilities
- Direct and coordinate aspects of Oscar claims processes including but not limited to: research, adjustments, and regulatory inquiries.
- Leverages industry background and knowledge of processes to influence others in sensitive complex situations while preserving relationships. Significantly influences departmental strategy by providing quantitative and qualitative inputs that drive organization success.
- Translates the claims department’s strategy into business plans and tactics in order to meet operational KPIs, targets and SLAs.
- Creates necessary structure to achieve programmatic and departmental goals.
- Understands and uses business and industry knowledge to inform strategy and execution.
- Supervise and train managers and employees as needed.
- Collaborate and communicate with other departments on claims issues, related projects and inter-departmental operations issues while developing effective, actionable solutions.
- Effectively manage processes and inter departmental initiatives through a collaborative approach to ensure timely results or issue resolution.
- Work cross collaboratively with various regulatory agencies, as well as Oscar’s legal, audit, and regulatory compliance teams.
- Compliance with all applicable laws and regulations.
- Other duties as assigned.
Qualifications
- 7+ years of experience in claims operations and processing, insurance products, and regulatory and policy language.
- 5+ years of people management and team leadership experience with ability to prioritize, allocate work and manage across multiple high-value projects at once.
- Experience analyzing and improving processes and workflows.
- Experience working with technical teams (e.g. engineering and product) to communicate our requirements, design tooling, and support technical troubleshooting.
- Experience forming data-driven, concrete answers in a world with imperfect information.
- Excellent leadership and communication skills to drive decision-making and results across multiple partners.
Bonus Points
- Bachelor's degree, or 4 years commensurate experience.
- Experience with benefit and contract interpretation or coding in professional/ institutional billing requirements.
- Experience managing claims across multiple product types ( i.e.Medicare or Commercial).
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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 ([email protected]) to make the need for an accommodation known.