Member & Provider Compliance Manager

Summary

Join Oscar, a health insurance company built on a technology platform, as a Manager, Member & Provider Compliance. You will ensure compliance excellence and operational integrity, representing Operations in regulatory discussions and preparing for Market Conduct Exams. Responsibilities include developing and implementing compliant policies and procedures, working with associates and senior leaders to address gaps, and managing a team. The role requires 5+ years of relevant experience in health insurance operations and experience with regulatory bodies. This is a blended work culture with a remote option, and compensation includes a competitive salary, benefits, unlimited vacation, and annual performance bonuses. The position is open to residents of several states.

Requirements

• 5+ years of relevant experience in a operations role within the health insurance industry
• 5+ years experience representing operational units with regulatory bodies in Market Conduct Exams including universe pulls, data analysis, and narrative development
• Experience developing, implementing, and managing Policies and Procedures within a healthcare organization
• Experience managing and developing a team

Responsibilities

• Be the subject matter expert for operational processes and systems to effectively represent the Operations organization in regulatory audits and reviews
• Develop and implement systems and processes to proactively identify potential compliance issues and continuously improve
• Develop, update, and streamline Policies and Procedures to ensure they are efficient and compliant, and coordinate with various departments to integrate into daily operations
• Develop team workflows and guidelines that produce consistent and measurable outcomes; train, teach and mentor team members to become more proficient and effective
• Collaborate across the organization, including owning stakeholder relationships to identify actions to achieve improvements and monitor initiative impact
• Support Oscar team members through knowledge sharing, process documentation, and tooling development
• Other duties as assigned
• Compliance with all applicable laws and regulations

Preferred Qualifications

• Experience managing complicated business challenges: developing understanding, distilling and communicating that understanding to technical and non-technical audiences
• An academic and professional background in engineering, data, or healthcare
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma certification
• Structured, systematic, and critical thinking
• Strong verbal and written communications
• 5+ years experience using data software (e.g. Excel, VGA, Macros, SQL and/or Python) to manipulate and analyze large data sets to solve business problems

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