Senior Claims Quality Control Analyst

Summary

Join Oscar's Total Quality Management team as a Senior Claims Quality Control Analyst! You'll support process improvement and issue resolution in Oscar's claim environment, leveraging your understanding of claim infrastructure and workflows. You will collaborate cross-functionally to translate stakeholder friction into actionable improvements. This role reports to the Associate Audit Lead and offers a blended work culture with remote options. The base pay varies by location and includes employee benefits, unlimited vacation, and annual performance bonuses. You'll be responsible for ingesting information, analyzing data, translating findings into business requirements, and proactively identifying areas for improvement. This position requires a bachelor's degree or equivalent experience and several years of experience in claims processing, data analysis, and stakeholder collaboration.

Requirements

• A bachelor’s degree or 4+ years of commensurate experience
• 3+ years experience in a claims processing environment and/or auditing within claims in healthcare operations
• 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 improving business workflows and processes
• 1+ years experience collaborating with internal and/or external stakeholders

Responsibilities

• Ingest information 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, 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
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• 2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)
• An academic and/or professional background in engineering, data, or healthcare
• Experience in a professional healthcare claims organization
• 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