VP, Claims System Configuration

Summary

Join Oscar as our Vice President, Configuration and lead our Claims and benefits configuration strategy. Partner with senior leaders across Operations, Technology, and other departments. Define, deliver, and measure efficient and effective claims models, impacting member and provider experiences. Lead a cross-functional technical implementation team, aligning with Oscar's corporate strategy and industry regulations. This role reports to the SVP, Infrastructure Operations and offers a blended work culture with remote options. The base pay is $232,000 - $305,500 per year, plus benefits.

Requirements

• 15+ years experience in claims and benefit management, and/or data analysis or consulting in the healthcare space
• 5+ years of experience in health plan administration configuration with an emphasis on designing and reengineering healthcare operational processes
• 10+ years of experience building, coaching and developing technical or operational teams
• 10+ years experience in analytics & ability to derive insights from complex, broad datasets
• Reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C

Responsibilities

• Define the claims design vision in partnership w/ key cross functional stakeholders and executives
• Lead the organization that supports and builds scalable processes for benefit configuration, claims adjudication, and provider payments identifying by the most important and impactful processes and systematically map them to apply technology to automate and improve them while ensuring compliance, quality and cost effectiveness
• Provide business requirements and cross functional support in the building, configuring, and improving Oscar’s technology platform(s) for adjudicating claims accurately and efficiently
• Manage, develop and maintain relationships cross-functionally to drive multi department collaboration to drive results for strategic initiatives
• Lead, coach and develop a high-performing team of managers and their reports - create a culture of compliance and end user satisfaction
• Set up monitoring and metrics to consistently and accurately track outcomes
• Manage team departmental budget
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• An academic and professional background in coding, math, statistics, engineering or data science
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training

Benefits

• Participation in Oscar’s unlimited vacation program
• Company equity grants
• 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