Manager, Complex Claims

Summary

Join Oscar as a Manager, Complex Claims and lead a team focused on improving complex claim outcomes. You will manage a portfolio of initiatives, develop team workflows, and mentor team members. The role involves reviewing specialized claims, conducting detailed analysis, and reporting to senior leaders. This is a blended work culture with a remote option available for those outside of commuting distance to our NYC, Tempe, or Los Angeles offices. The position requires a bachelor's degree or equivalent experience and several years of experience in claims management, data analysis, and workflow improvement. Competitive salary and benefits are offered.

Requirements

• A bachelor’s degree or 4+ years of commensurate experience
• 4+ years leading, coaching and developing direct reports in a claims environment
• 4+ years of experience analyzing data to solve complex claims problems
• 2+ years experience designing, implementing and improving business workflows

Responsibilities

• Be the subject matter expert for Claims operations through knowledge and expertise of Oscar’s claim platform, claim regulatory requirements and operational workflows
• Manage a complex portfolio of initiatives and deliverables and proactively identify areas of opportunity to improve key performance indicators
• Develop team workflows and guidelines that produce consistent and measurable outcomes; train, teach and mentor team members to become more proficient and effective
• 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
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• Process Improvement or Lean Six Sigma training, certification
• Experience developing project plans in collaboration with internal and external stakeholders
• Experience with healthcare claims processing

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