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Hi, we're Oscar. We're hiring a Manager, Complex Claims to join our Claims Production team.
Oscar is the first health insurance company built around a full stack technology platform & a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.
About the role
The Manager, Complex Claims leads a team tasked with tactical & strategic initiatives with the goal of improving complex claim outcomes across a series of key performance metrics. The Manager plays a critical role in the overall claims improvement apparatus by providing leadership, structure & organization, enabling the team to succeed.
You will report to the Associate Director, Claims Production.
Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture & our mission.
If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.
You must reside in one of the following states: Alabama, Arizona, Arkansas, 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. Note, this list of states is subject to change. #LI-Remote
Pay Transparency:
The base pay for this role in the states of California, Connecticut, New Jersey, New York, & Washington is: $103,200 - $129,000 per year. The base pay for this role in all other locations is: $92,880 - $116,100 per year. You are also eligible for employee benefits, participation in Oscars unlimited vacation program & annual performance bonuses.
Responsibilities
- Be the subject matter expert for Claims operations through knowledge & expertise of Oscars claim platform, claim regulatory requirements & operational workflows
- Manage a complex portfolio of initiatives & deliverables & proactively identify areas of opportunity to improve key performance indicators
- Develop team workflows & guidelines that produce consistent & measurable outcomes; train, teach & mentor team members to become more proficient & effective.
- Lead teams for the review of highly specialized claims processing including: high cost claims, transplants, COB & other third-party insurance
- Conducting detailed information gathering, analysis & investigation to find solutions, & reporting to senior leaders on complex claims trends & developments
- Compliance with all applicable laws & regulations
- Other duties as assigned
Qualifications
- A bachelors degree or 4+ years of commensurate experience
- 4+ years leading, coaching & developing direct reports in a claims environment
- 4+ years of experience analyzing data to solve complex claims problems
- 2+ years experience designing, implementing & improving business workflows
Bonus Points
- Process Improvement or Lean Six Sigma training, certification
- Experience developing project plans in collaboration with internal & external stakeholders
- Experience with healthcare claims processing
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves & find both belonging & support. We're on a mission to change health care -- an experience made whole by our unique backgrounds & perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, & experience. Full-time employees are eligible for benefits including: medical, dental, & vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life & disability insurance, & paid wellness time & reimbursements.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar.
California Residents: For information about our collection, use, & disclosure of applicants personal information as well as applicants rights over their personal information, please see our Notice to Job Applicants.
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