Oscar is hiring a
Senior Specialist

Summary

Join Oscar's Claims Quality team as a Senior Specialist, Claims Quality Regulatory Operations. The role involves supporting compliance within Provider Operations by coordinating responses and delivering positive outcomes based on inputs from stakeholders. You will help advance compliance efforts by conducting detailed data analysis, supporting the preparation of Market Conduct Exam exhibits/narratives and the policies & procedures review process within Operations.

Requirements

• Demonstrated understanding of Provider operations in the health payer industry
• 1+ years of relevant experience working with operational compliance, regulatory, and data analysis within Healthcare Claims
• 1+ years experience designing and improving workflows

Responsibilities

• Collaborate with team members and leaders to address process gaps and improvements
• Review data pulls and conduct detailed analysis to support compliance initiatives
• Develop trusting relationships with internal and external stakeholders through effective communication and collaboration
• Draft detailed narratives and reports to communicate compliance findings and updates, including responses to Regulator/NCQA requests and examinations
• Support creation of Policies & Procedures within Operations, ensuring that all policies and procedures are up-to-date and meet internal requirements as outlined by Compliance team
• Assist in preparing for Market Conduct Exams and other regulatory reviews
• Stay informed on business requirements and act on regulatory updates guided by Oscar’s Compliance team to ensure adherence to effective processes and procedures
• Other duties as assigned

Benefits

• Full-time employees are eligible for benefits including: 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