Hi, we're Oscar. We're hiring a Director to join our Insurance Operations team in our New York City office.
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 the role:
The Payment Integrity team at Oscar focuses on Oscar's company-wide goal to make healthcare more affordable & efficient by designing scalable processes & building data-driven solutions powered by technology. Our work favorably impacts Oscar's price position through reducing claims payment leakage & surfacing & addressing fraudulent, wasteful, & abusive practices. The Payment Integrity team drives several operational programs, including payment policies, high risk claims reviews, claims audit & edit processes.
You will ensure the integrity of Oscar's claim payments by setting & completing a creative vision for building an outstanding, scalable claims cost management program that uses technology, deep expertise, & lean operations. You will partner with a broad set of leaders across the organization to achieve this mission.
You will report to the Senior Director, Payment Integrity.
- Provide leadership for payment integrity operations to ensure strategic, operational, & financial goals are met on a quarterly & annual basis
- Set & achieve quarterly & annual operational & financial targets for responsibilities
- Manage the three-year roadmap to build an industry-leading function
- Guide detailed requirements for payment integrity solutions
- Build & provide sustainable processes that ensure accuracy of claim processing & provider payments
- Communicate complex topics to senior leadership to drive enhanced understanding
- Engage & build relationships with important internal partners, including the Data, Special Investigations Unit, Legal, Market P+L, Clinical, & Tech teams
- Mentor staff to build new approaches to payment integrity & strengthen Oscar's culture
- A bachelor's degree or commensurate years of experience
- 8+ years of progressive experience managing claims, Payment Integrity, Fraud Waste Abuse, Clinical Editing, Clinical coding, claims audit for Health Plans
- 4+ years of experience developing & inspiring teams
- Expert understanding of claim payment methodologies, billing software/analytics, & revenue lifecycle
- Familiarity with medical terminology, DRG/APC payment methodologies, professional & facility coding, or billing analytics platforms
- Experience working in a fast paced environment
- Experience achieving financial & operational goals
- Professional or institutional coding certification (e.g., CPC)
- Experience with competitive analysis or benchmarking
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 encourage our members to care for their whole selves, & we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.
Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (email@example.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.