Oscar is hiring a
Associate Director

Summary

Join Oscar's Claims team as an Associate Director, Claims Production and lead a team of production leaders in managing open claim inventory, claim payment timeliness, and producing/managing/reporting on key performance indicators. You will report to the Senior Director, Claims.

Requirements

• 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+ Experience with benefit and contract interpretation or coding in professional/ institutional billing requirements
• 3+ Experience managing claims across multiple product types (i.e. Medicare or Commercial)
• 3+ Experience analyzing and improving processes and workflows
• 5+ Experience working with technical teams (e.g. engineering and product) in translating business requirement specifications

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

Preferred Qualifications

• 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

Benefits

• 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
• Paid wellness time and reimbursements