Senior Analyst, Claims Production

Summary

Join Oscar's Claims Production team as a Senior Analyst and support process improvement and complex claims issue resolution. You will leverage your deep understanding of cross-functional collaboration to translate stakeholder friction into actionable improvements. This role involves ingesting information from internal and external partners, translating findings into business requirements, and proactively identifying areas for problem-solving. You will also perpetuate a culture of transparency and collaboration, support Oscar's state objectives, and coordinate projects to meet key milestones. The position requires a bachelor's degree or 4+ years of equivalent experience and 3+ years of experience in healthcare claims, working with large datasets, deriving business insights, and improving workflows. The role offers a blended work culture with remote options and competitive benefits.

Requirements

• A bachelor’s degree or 4+ years of commensurate health plan experience
• 3+ years experience in healthcare claims organization
• 3+ years experience working with large data sets using excel or a database language and root-cause analysis
• 3+ years experience deriving business insights from datasets and solving problems
• 3+ years experience improving business workflows and processes
• 3+ years experience collaborating with internal and/or external stakeholders
• 1+ years experience in operations or quality analytics

Responsibilities

• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions of complex claims issues
• Translate observations, findings and analysis results into detailed–often technical–business requirements; submit to and collaborate with internal partners to effectuate change
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership
• Coordinate projects and processes to help ensure key milestones and service levels are met
• Partner with leadership to strategize, implement, and manage arrangements aimed at lowering overall cost or improving outcomes
• Partner with cross-functional teams to ensure action plans align with continuous improvement goals, and participate in collaboration with peers and cross-functional stakeholders
• Support the management, stewardship, and analysis of data to support compliant and performant business operations
• Provide recommendations that ensure financial discipline and quality
• Support identifying and implementing process improvement initiatives, as well as mindset shifts,  to optimize operational efficiency and achieve performance targets
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training andsExperience using BigQuery or Looker Studio

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