Manager, Complex Claims

Summary

Join Oscar's Claims Production team as a Manager, Complex Claims! You'll lead a team responsible for timely and accurate processing of complex health insurance claims. This role involves adjudicating intricate claims, conducting thorough investigations, and ensuring team performance meets goals. You'll also develop team members and identify operational improvements. The position offers a blended work culture with remote options and a competitive salary and benefits package. The role requires experience in healthcare claims and team leadership, along with strong analytical skills. Additional experience in remote leadership, process improvement, or BPO environments is beneficial.

Requirements

• Bachelor's degree or 4 years of commensurate experience
• 4+ years of experience leading, coaching and developing direct reports in a healthcare claims production environment
• 3+ years of experience with using data and metrics to problem solve and drive root cause analysis

Responsibilities

• Adjudicate highly complex claims with technical complexity and coordination ensuring claims are processed timely and accurately
• Lead teams for the review of highly specialized claims processing including: high cost claims, transplants, COB and other third-party insurance
• Conducting detailed information gathering, analysis and investigation to find solutions, and reporting to senior leaders on complex claims trends and developments
• Conduct file reviews to ensure accuracy
• Ensure team meets daily, monthly and annual production goals and performance objectives for both quality and productivity
• Creating, tracking, and implementing best practices for Production Management to improve overall member experience through daily queue management and production tracking
• Utilize frameworks to intentionally develop and coach your team in order to build future leaders within the organization
• Take a proactive, forward-thinking and data-driven approach to identify concerns, inefficiencies, and operational improvement initiatives throughout the Claims space that drive desired cultural and operational outcomes
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• Proficiency in Microsoft Office Suite
• Process Improvement or Lean Six Sigma training, certification
• Experience as a leader in a remote environment
• Experience in BPO or Call Center environments

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