Associate Director, Claims Documentation

Summary

Join Oscar as an Associate Director, Claims Documentation and contribute to improving claims processing workflows, policies, and procedures. You will leverage your strong writing skills and healthcare claims knowledge to collaborate with various stakeholders. This role involves analyzing workflows, identifying inefficiencies, and recommending best practices. You will also be responsible for developing and maintaining detailed process documentation, ensuring compliance with industry standards and regulations. The position requires significant experience in claims operations, people management, and process improvement. Oscar offers a blended work culture with remote options and a competitive compensation and benefits package.

Requirements

• 7+ years of experience in claims operations including, communication or other Technical writing
• 5+ years of experience in people management and team leadership experience with ability to prioritize, allocate work and manage across multiple high-value projects at once
• 3+ years of experience with benefit and contract interpretation or coding in professional/ institutional billing requirements
• 3+ years of experience managing claims across multiple product types (i.e. Medicare or Commercial)
• 3+ years of experience analyzing and improving processes and workflows
• 5+ years of experience working with technical teams (e.g. engineering and product) in translating business requirement specifications

Responsibilities

• Develop and maintain detailed process documentation, including standard operating procedures (SOPs), work instructions, and guidelines related to healthcare claims processing specifically
• Ensure accuracy, clarity, and compliance with industry standards and regulatory requirements
• Analyze current claims processing workflows to identify inefficiencies and areas for improvement
• Work closely with internal claims department stakeholders and audit teams and tech partners to understand existing processes and recommend best practices
• Stay updated on healthcare regulations, including HIPAA, CMS guidelines, and insurance policies, to ensure compliance in documentation and processes
• Work with cross-functional teams, including Tech, quality assurance, and compliance teams, to gather information and improve process efficiency
• Translate technical or complex information into clear, user-friendly documentation
• Assist in developing training materials, FAQs, and user manuals for new hires and existing staff
• Manage open provider claim dispute inventory and mitigation of interest bearing claims payment
• Responsible for ongoing career development of the team by maintaining culture, employee satisfaction and team performance management
• Develop annual and ad-hoc training program for team members and managers
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• Bachelor's degree in communications, or 4 years commensurate experience
• 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

• 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
• Annual performance bonuses
• Oscar’s unlimited vacation program