Director, Claims Process Improvement

Summary

Join Oscar as a Director, Process Improvement and lead a team in optimizing claims processes, ensuring compliance, and achieving departmental goals. You will develop and implement operational plans to enhance efficiency and scalability. This role requires extensive experience in healthcare strategy, operations, and leadership, along with a deep understanding of claims processing. The position offers a competitive salary, benefits including medical, dental, vision, paid time off, 401k, and more. Work location is flexible, with options for remote work or in-office presence in select cities. The ideal candidate will possess strong leadership, process improvement, and technical skills.

Requirements

• Bachelor's Degree in related field or 4+ years of commensurate experience
• 10+ years of experience in healthcare strategy and operations, and or related field
• 6+ years of leadership experience
• 2+ years of experience in program management and/or process design or implementation
• 10+ years of experience in a cross-functional operations environment
• 3+ years of experience working at a health plan/payer

Responsibilities

• Maintain responsibility for the continuous improvement of claims processing procedures and ensure adherence to established claims operations procedures throughout the organization
• Lead a team in the optimization of claims process documentation, and development and execution of claims department training
• Collaborate with Operations and Technology team leadership to identify and implement claims system performance strategies
• Lead creation of short- and long-term roadmap planning process to meet organization goals, identifying important resources and requirements to meet plans' goals
• Establish and monitor measures to ensure compliance with industry regulations, internal policies and best practice principles around claims processing
• Work with internal tech partners to ensure a coordinated approach in leadership of claims processing, training, performance monitoring, system and process optimization and technology
• Lead, coach and develop a high-performing team of managers and their reports
• Develop and continuously improve foundational processes
• Ensure operational compliance with all relevant regulatory/ accreditation agencies and meets contractual requirements
• Lead team to surface data, process, and technology issues through proactive identification, measurement, and monitoring of operations; partner cross functionally to develop end-to-end strategy that leverages these insights to scale
• Manage, develop and maintain relationships cross-functionally to drive multi department collaboration to drive results for strategic initiatives
• Own team vision and strategy including quarterly vital setting and multi-year roadmap
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• Master’s degree
• Lean / Six Sigma experience
• Financial modeling experience
• Extensive knowledge of claims operations and processing, insurance products, contracts, and regulatory and policy language
• Experience working with technical teams (i.e. engineering and product) to communicate our requirements, design tooling, and support technical troubleshooting
• Experience forming data-driven, concrete answers in a world with imperfect information
• Proficient in technical writing

Benefits

• Employee benefits
• Participation in Oscar’s unlimited vacation program
• Company equity grants
• 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