Associate Director, Claims Production - Oscar Health
Tempe, AZ
About the Job
Hi, we're Oscar. We're hiring a Associate Director, Claims Production 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
In this role, you will lead a team of production leaders that are responsible for managing open claim inventory, claim payment timeliness, and producing/managing/reporting on key performance indicators that drive the business and mitigate risk.
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 Dr), 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, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, 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: $119,200 - $156,450 per year. The base pay for this role in all other locations is: $107,280 - $140,805 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.
Responsibilities
- Manage open claim inventory and mitigation of interest bearing claims payment
- Oversee cross functional claims divisions including but not limited to: production, adjustment, and disputes work units
- Collaborate with business leaders and internal stakeholders to set strategy, align on organization structure, and evaluate people-based business decisions
- Direct and coordinate aspects of Oscar claims processes including but not limited to: research, adjustments, and regulatory inquiries or escalations from providers
- Leverages industry background and knowledge of processes to influence others in complex situations. 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
- 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.
- Responsible for ongoing career development of the team, maintaining culture and employee satisfaction. Supervise and train managers and employees as needed.
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- 7+ years of experience in claims operations including adjudication, adjustments and inventory management
- 5+ years of people management and team leadership experience with ability to prioritize, allocate work and manage across multiple high-value projects at once
- 3+ years experience with benefit and contract interpretation or coding in professional/ institutional billing requirements.
- 3+ years experience managing claims across multiple product types (i.e. Medicare or Commercial)
- 3+ years experience analyzing and improving processes and workflows
- 5+ years experience working with technical teams (e.g. engineering and product) in translating business requirement specifications
Bonus Points
- Bachelor's degree, or 4 years commensurate experience
- CPC or other professional coding certification
- Experience in making data-driven decisions in a fast paced environment
- Excellent leadership and communication skills to drive decision-making and results across multiple partners
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.
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 Notice to Job Applicants.
