Operations Associate, Claims Design

Summary

Join Oscar's Claims Design team as an Operations Associate and design, optimize, and implement processes and improvements for our claims adjudication platform. You will identify, scope, build, test, and implement solutions focused on efficiency and scale through technology and automation. This role requires understanding Oscar's infrastructure, logic, and data models, and collaborating cross-functionally to translate business requirements into technical implementations. The position offers a competitive salary, benefits, and the opportunity to work remotely or in one of our offices (NYC, Tempe, or Los Angeles). You will report to the Manager, Claims Design. The role requires a bachelor's degree or equivalent experience and 3+ years of experience in a technical role and using data software.

Requirements

• Possess a bachelor’s degree or 4+ years of commensurate experience
• Have 3+ years of experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering)
• Have 3+ years of experience using data software such as SQL or Python
• Possess experience in analytics & the ability to derive insights from complex, broad datasets
• Demonstrate proficiency in designing and improving workflows as well as standing up accompanying operating and technical procedures

Responsibilities

• Design and prioritize operational processes by working cross-functionally to gather business requirements and implementing process- and technology-enabled solutions
• Lead and cross-collaborate on iterative problem definition and technical design and scoping to build solutions with the end-user in mind
• Utilize data to independently drive business decisions, impact cross-functional strategy and develop KPIs to measure the effectiveness of your domain
• Serve as a subject matter expert in the claims payments and overpayments process within the claims lifecycle
• Proactively identify risks; respond to and resolve issues/errors/escalations through data-driven investigation to produce insights for short, medium, and long-term technology-enabled solutions
• Distill the requirements of new product and market expansions and design automated workflows to reduce manual work requirements
• Work with engineers, analysts and other Operations team members to resolve escalations, develop training, and create technical tooling to enable others
• Understand the operations ecosystem, technology and data models; its current strengths, weaknesses, and gaps; and connect the dots for other teams
• Comply with all applicable laws and regulations
• Perform other duties as assigned

Preferred Qualifications

• Have an academic and professional background in coding, math, statistics, engineering or data science
• Have experience in knowledge management, training, or content development in operational settings
• Have Process Improvement or Lean Six Sigma training
• Have experience in healthcare or startup environments - specifically with claims adjudication
• Possess proficiency with Python

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
• Annual performance bonuses
• Unlimited vacation program