Claims Quality Senior Analyst

Summary

Join Oscar's Claims Quality team as a Senior Analyst and contribute to process improvement and issue resolution within our claims environment. Leverage your expertise in claims infrastructure, workflows, and data analysis to develop solutions and drive change. You will collaborate with internal and external partners, translate findings into business requirements, and proactively identify areas for improvement. This role requires a deep understanding of healthcare claims and experience in process improvement. The position offers a blended work culture with remote options and a competitive salary and benefits package, including performance bonuses, unlimited vacation, and comprehensive health and wellness benefits.

Requirements

• 3+ years of experience in claims processing or auditing within healthcare operations
• 2+ years experience improving business workflows and processes
• 1+ years experience collaborating with internal and/or external stakeholders

Responsibilities

• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions
• Utilize data analysis skills and tools to develop accurate, quantitative analyses of claims issues
• Translate observations, findings and analysis results into business requirements; submit to and collaborate with internal partners to effectuate change
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• A bachelor’s degree or 4+ years of commensurate experience
• An academic and/or professional background in engineering, data, or healthcare
• Experience in a professional healthcare claims organization
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training ands
• Experience using SQL

Benefits

• Employee benefits
• Participation in Oscar’s unlimited vacation program
• Annual performance bonuses
• 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