Senior Manager, Payment Integrity

Summary

Join Oscar's Payment Integrity team as a Senior Manager! You will identify and prioritize claims improvement opportunities, hold teams accountable, and develop strategic plans. This critical role involves leadership, coaching, and developing direct reports to achieve best-in-class results. You'll design, guide, and assess operational frameworks, reporting to the Senior Director, Payment Integrity. The position offers a blended work culture with flexibility depending on location, and competitive compensation including benefits and bonuses. The role requires significant experience in healthcare operations, data analytics, and team leadership.

Requirements

• 6+ years experience in operations, healthcare, data analytics and/or consulting
• 6+ years of experience analyzing data to solve complex business problems
• 3+ years of experience leading and developing a team
• 3+ years experience designing, implementing and improving business workflows
• 6+ years experience in medical coding
• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
• Expert level experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices

Responsibilities

• Be the subject matter expert for Payment Integrity policies and claims processing edits through knowledge and expertise of Oscar’s claim platform, claim coding and regulatory requirements and operational workflows
• Anticipate, overcome, and prevent recurrence of complex problems and roadblocks in an efficient and effective manner
• Create routines that drive cross-functional collaboration within and outside of department
• Develop and implement standard Payment Integrity policies, procedures and workflows
• Drive ideation of payment integrity opportunities
• Manage inquiries related to Oscar edits & disputes
• Monitor performance of Oscar edits, including but not limited to monthly quality audits
• Participate in governance committee activities to ensure alignment with internal stakeholders & business decisions
• Translate a strategic vision for the team and outline clear and measurable performance metrics / OKRs
• Coach, develop and lead a team to achieve identified outcomes
• Provide leadership in complex, cross-functional initiatives focused on claims improvement
• Manage a portfolio of initiatives and deliverables and proactively identify areas of opportunity to improve key performance indicators
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• Process Improvement or Lean Six Sigma training, certification
• Experience managing in a healthcare claims organization
• Experience using SQL

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
• Oscar’s unlimited vacation program