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Oscar Health // health insurance
 
Tempe, Arizona, United States    Posted: Thursday, September 17, 2020
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring a Regulator Case Management Expert to join our Complaints, Grievances & Appeals (CGA) 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.

The Oscar Complaints, Grievance & Appeals Department plays an important role at Oscar.  We are responsible for responding to complaints from our members according to state & federal requirements.  We are Powered by People who have a passion for refactoring healthcare & are committed to Seek the Truth & to Make it Right.  

As a senior member of the CGA team, your primary role as a Regulatory Expert is to address complaints received from state & federal regulatory agencies that have oversight of Oscars health plans.  Additionally, you may support audits (internal/external), accreditation activities, & regulatory reporting submissions for the CGA department.

You are responsible for handling regulator inquiries & in so doing, mitigate regulatory risk to the company.  You will work independently on complex cases requiring originality & ingenuity with some latitude for un-reviewed actions or decisions.  

You will report into the Sr. Manager of CGA.

Responsibilities:

  • Seek complete & timely resolution of Regulator complaints by establishing strong relationships & setting expectations with internal partners
  • Pinpoint & identify the underlying questions being posed by the Regulator & address both the de facto complaint as well as the underlying operational question
  • Identify operational issues & trends within Oscar, delegates & other external stakeholders, communicate these issues, & assist in formulating appropriate remediation plans with CGA Leadership
  • Coordinate with the CGA Data Analyst, Compliance & Regulatory Affairs to ensure that reports are delivered timely & accurately
  • Communicate regulator directives by state to Team & support partners to create awareness to all stakeholders & to ensure directives are incorporated into documented procedures
  • Work as a team to complete departmental tasks to meet deadlines & accomplish department objectives. This may include evenings, weekends & holidays

Requirements:

  • Bachelors degree or equivalent experience 
  • 2+ years healthcare experience in a Complaints, Grievances and/or Appeals role 
  • 1+ years experience working with Regulators (state or federal) in a healthcare setting
  • Knowledge of insurance industry & regulatory compliance to applicable state & federal laws

Bonus Points:

  • Prior audit experience 
  • Knowledge of regulatory reporting obligations & procedures preferred
  • Ability to resolve complex situations with internal partners & regulators, while maintaining a professional presence
  • Work under pressure on multiple tasks concurrently & meet deadlines 
  • Use appropriate analysis, judgment & logic when solving problems & making decisions.
  • Advanced business writing & exemplary listening & verbal communication skills

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. 

 
 
 
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