Associate Director, Claims Process Optimization

Summary

Join Oscar as an Associate Director, Process Optimization and lead a team in designing and implementing process improvements for our claims technology. You will collaborate with internal and external teams to optimize claims processing, increase payment quality, and drive efficiency through automation. This role requires strong analytical skills, experience in health plan operations, and a proven ability to lead and develop technical teams. The position offers a blended work culture with remote options and a competitive salary and benefits package, including medical, dental, vision, paid time off, 401k, and more. You will report to the Director, Claims Process Optimization and be responsible for team strategy and influencing department-level strategy. The ideal candidate will have experience in health plan administration configuration and process improvement methodologies.

Requirements

• A bachelor’s degree or 4 years commensurate experience
• 7+ years of experience in health plan operations, health insurance, and/or data analysis or consulting in the healthcare space
• 7+ years of experience using data software such as Excel, SQL or Python
• 4+ years of experience building, coaching and developing technical or operational teams
• 3+ years of experience in analytics & ability to derive insights from complex, broad datasets
• 3+ years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures

Responsibilities

• Develop foundational processes for our scaling claims operations and summarize the complexity of Claims data and operations into clear explanations
• Develop business requirements operational improvements to Oscar’s claims processes to ensure compliance, improve scalability, and manage risks
• Collaborate with internal teams and external vendors and partners to deliver on expansion and platform targets and key operational metrics
• Surface data, process, and technology issues through proactive identification, measurement, and monitoring of claims operations
• Partner closely with Product & Engineering and/or Data Science orgs to deliver the next generation of health insurance operations
• Work with collaborators within the Claims team and partners across the rest of Insurance Operations and cross-functionally to ensure the successful launch of new markets, lines of business, and partnerships by the target launch date for Oscar’s full portfolio
• Through Oscar’s infrastructure, underlying logic, and data models this role works cross-functionally to understand and translate requirements/rules from business stakeholders to enable technical implementation
• Identify either process or training deficiencies through the review of audit results, provider disputes, provider complex escalations and other claims payment trends and implement changes to correct
• Owns team strategy and influences department level strategy
• Owns, designs and prioritizes technical operations roadmaps working cross functionally to gather business requirements in order to implement and improve the efficacy and efficiency of existing operational processes or to unlock new platform capabilities
• Utilizes data to independently drive business decisions, impact cross-functional strategy and develop KPIs to measure the effectiveness of your domain
• Proactively identify risks; responds to and resolves issues/errors/escalations through data-driven investigation to produce insights for short, medium, and long-term technology-enabled solutions
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• An academic and professional background in coding, math, statistics, engineering or data science
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training
• Experience in health plan administration configuration

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