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Oscar Health // health insurance
 
Los Angeles, California, United States    Posted: Wednesday, August 12, 2020
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring a Benefits Configuration leader to join our Health Insurance Plan Design team.

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 & headquartered in New York City. Our goal is to make health insurance simple, transparent, & human. We need your help to do so.

About this role:

The Insurance Product team is responsible for developing Oscars plan portfolio strategy for the Individual, Small Group, & Medicare Advantage markets.  We ensure that our plan designs meet the needs of a diverse marketplace.  We collaborate with Legal & Regulatory Affairs teams to ensure that our plans designs comply with state & federal requirements & provide materials required for annual Qualified Health Plan (QHP) filings.  We also work with cross-functional teams to implement our plan benefits.

As a Director of Benefit Configuration, you will develop business strategies & a framework, forming a basis for Benefit & Coverage Configuration policies.  You will be accountable for developing processes to document configuration rules, establishing consistency & efficiency in translating business decisions into claims configuration requirements.  You will provide tools & templates to manage end-to-end processes (business requirements templates, change management processes, business analysis models, etc.).  You will lead benefit interpretation reviews & develop business decision proposals with the support of a cross-functional committee.

You will collaborate with our Claims & Technology teams to identify & resolve configuration/processing issues.  Close partnership with these teams will be needed to ensure alignment with business decisions & technical & operational capabilities. In addition, you will partner with Product, Engineering, & Data teams to construct scalable technical solutions to benefit configurations.  This role will support all Oscar states & will work closely alongside other Oscar teams including Legal, Clinical, Finance, Data, & Actuarial teams to ensure that Oscars processes are compliant with state & federal rules, aligned with industry standards, & reflects best practices.

In this role, you will report to the Head of Insurance Product. 

Responsibilities:

  • Ensure consistency & standardization in benefit configuration processes.
  • Analyze benefit configuration for new & existing plans.
  • Lead benefit interpretation review process with a cross-functional committee.
  • Develop provider-facing coverage/clinical guidelines documentation
  • Conduct root-cause analysis on benefit set-up issues across all products & develop impact analysis for proposed configuration changes.
  • Develop & document policies & relevant background information for other departments to better understand benefits configuration across products.
  • Research & engage with industry leaders to evaluate & provide insights, & competitor best practices as applicable.

Requirements:

  • Bachelor's Degree 
  • 8+ years of relevant work experience developing & managing health insurance benefit configuration processes, claims operations, other related healthcare functions.
  • Experience building, managing, & developing teams
  • Experience collaborating with stakeholders at varying leadership levels
  • Experience leading cross-functional initiatives 

Bonus points:

  • Experience using technical skills (e.g. SQL, Python) to solve problems
  • Experience solving problems & providing clarity in ambiguous environments 

Life at Oscar: 

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.

We aim to make health care affordable & accessible for all, & apply this same vision to our perks & benefits, including: medical benefits, unlimited paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.

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.

Pay Transparency Policy:

Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

 
 
 
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