Manager, Complex Issue Resolution

Summary

Join Oscar as a Manager, Complex Issue Resolution and lead a team focused on complex claim analysis and issue resolution. You will improve claim outcomes, provide leadership and structure to your team, and report to the Associate Director, Disputes. This role offers a blended work culture with a remote option, provided you reside in one of the specified states. The salary range varies by location and includes benefits such as unlimited vacation, annual performance bonuses, and comprehensive health insurance. You will be responsible for managing a team of claims professionals, ensuring quality and compliance, and developing team workflows. The ideal candidate possesses a bachelor's degree or equivalent experience and extensive experience in healthcare claims.

Requirements

• A bachelor's degree or 4+ years of commensurate experience
• 4+ years leading, coaching and developing direct reports in a healthcare claims organization
• 4+ years of experience analyzing data to solve complex claims problems
• 2+ years experience leading implementation of sustainable and scalable process and workflow improvements

Responsibilities

• Be the subject matter expert for Claims operations through knowledge and expertise of Oscar's claim platform, claim regulatory requirements and operational workflows
• Lead a team of analysts to conduct root-cause analysis of complex claims issues. Create and suggest plans for correction, overseeing implementation and measuring success. Document and report findings to leadership
• Manage a team of claims professionals, ensuring quality, accuracy, and compliance in all claims processes. Provide coaching, professional development, and performance management for team members
• Develop team workflows and guidelines that produce consistent and measurable outcomes; train, teach and mentor team members to become more proficient and effective
• 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
• Experience managing in a healthcare claims organization
• Experience with SQL and basic SQL abilities

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