Senior Analyst, Payment Integrity Data Mining

Summary

Join Oscar's Payment Integrity team as a Data Mining Senior Analyst! You'll be responsible for creating, researching, and developing overpayment concepts, ensuring the quality of payments, and improving processes. Leveraging your understanding of Oscar's claim infrastructure and data models, you'll collaborate cross-functionally to translate stakeholder friction into actionable improvements. This role reports to the Senior Manager, Payment Integrity and offers a blended work culture with remote options. The base pay varies by location and includes benefits such as unlimited vacation, annual performance bonuses, and comprehensive health insurance.

Requirements

• A bachelor’s degree or 4+ years of commensurate experience
• 2+ years experience in claims auditing, healthcare payment integrity or similar
• 2+ years of experience working with large data sets using excel or a database language
• 1+ years experience deriving business insights from datasets and solving problems
• 1+ years experience in healthcare
• 1+ years experience collaborating with internal and/or external stakeholders

Responsibilities

• Quality review claim and concept findings from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions
• Utilize data analysis skills and tools to develop accurate, quantitative analyses of issues
• Translate observations and analysis results into actionable findings; submit to and collaborate with internal partners to effectuate change
• Use insights from vendor submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to reduce incorrect payments
• 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
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• An academic and/or professional background in healthcare
• Experience in a professional healthcare payment integrity or claims auditing organization
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training ands
• Experience using SQL

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