Hi, were Oscar. Were hiring a Senior Analyst to join our Payment Integrity 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. <h3>About the role</h3> This role is responsible for supporting process improvement and issue resolution in the Oscar claim environment for both the Oscar Insurance business and +Oscar clients. The Senior Analyst, Payment Integrity role organizes, scopes, prepares, investigates and/or executes on solutions and process improvements within edits and ideation. This is accomplished by leveraging a deep understanding of Oscars claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement. You will report to the Senior Manager, Payment Integrity. 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. This is a hybrid role in our Los Angeles, California office. You will work part of the time in the office and part of the time remote / work-from-home. #LI-Hybrid Pay Transparency: <div> The base pay for this role is: $69,600 - $91,350 per year. You are also eligible for employee benefits, participation in Oscars unlimited vacation program and annual performance bonuses. </div> <h3>Responsibilities</h3> <ul> <li>Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.</li> <li>Respond to internal and external inquiries and disputes regarding policies and edits.</li> <li>Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.</li> <li>Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.</li> <li>Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.</li> <li>Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.</li> <li>Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.</li> <li>Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.</li> <li>Compliance with all applicable laws and regulations</li> <li>Other duties as assigned</li> </ul> <h3>Qualifications</h3> <ul> <li>A bachelors degree or 4+ years of commensurate experience</li> <li>3+ years of experience in claims processing, coding, auditing or health care claims operations</li> <li>3+ years experience in medical coding within payment integrity</li> <li>Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)</li> <li>Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.</li> <li>2+ years experience deriving business insights from datasets and solving problems</li> <li>1+ years experience improving business workflows and processes</li> <li>1+ years experience collaborating with internal and/or external stakeholders</li> </ul> <h3>Bonus points</h3> <ul> <li>2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)</li> <li>Process Improvement or Lean Six Sigma training</li> <li>Experience using SQL</li> </ul><div>This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud<a href="http://hioscar.com/careers/recruitment-fraud-alert"> here</a>.  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. Were 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. Artificial Intelligence (AI) Guidelines: Please see our <a href="http://hioscar.com/careers/ai-guidelines">AI Guidelines</a> for the acceptable use of artificial intelligence during the interview process at Oscar. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our <a href="https://www.hioscar.com/notice-to-job-applicants">Notice to Job Applicants</a>.</div>

Oscar Health

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