Director, Claims and Benefits Configuration

Summary

Join Oscar as the Director, Claims and Benefits Configuration and lead a team managing plan and benefit configuration. Develop and execute the configuration roadmap, collaborating with various teams. Oversee data utilization for business decisions and develop KPIs. Proactively identify and resolve risks. Provide expertise to solve organizational issues. This role offers a blended work culture with remote options and a competitive salary and benefits package. The position requires a bachelor's degree or equivalent experience, extensive experience in health plan operations, team leadership, analytics, and health plan configuration. The role is open to candidates residing in several states.

Requirements

• A bachelor’s degree or 4 years commensurate experience
• 10+ years experience in health plan operations, health insurance, and/or data analysis or consulting in the healthcare space
• 7+ years of experience building, coaching and developing technical or operational teams within healthcare
• 6+ years experience in analytics & ability to derive insights from complex, broad datasets
• 6+ years  in designing and improving workflows as well as standing up accompanying operating and technical procedures
• Experience in health plan configuration, specifically benefit concepts

Responsibilities

• Lead, coach and develop a high-performing team
• Creates team strategy and participates in setting department level strategy
• Owns and prioritizes Configuration 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
• Oversee the utilization of data to independently drive business decisions, drive cross-functional strategy and develop KPIs to measure the effectiveness of your domain
• Proactively identify and review risks; oversee responses to and resolutions to issues/errors/escalations through data-driven investigation to produce insights for short, medium, and long-term technology-enabled solutions
• Provides expertise and works across departments and with senior leadership to solve organizational issues
• 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
• Working knowledge of contract and rate 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