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Oscar Health // health insurance
 
Tempe, Arizona, United States    Posted: Saturday, March 27, 2021
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring a Bilingual Clinical Concierge Specialist to join our Complex Case Management team in our Tempe  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:

As a Clinical Concierge Specialist, you will be a part of the case management department speciality team (transplant, complex case management and/or behavioral health). Youll help members navigate the complexity of the healthcare system, answering questions & resolving issues in direct collaboration with a case manager (RN/SW) & teams across the company.

You will report into the Manager of CCM Operations.

Responsibilities:

  • Work in direct collaboration with the case managers to support member needs
  • Assist members with claims questions & understand how claims may be processed differently (e.g. place claims hold for transplant members)
  • Make sure authorizations (medrev/utilrev) are current & attached to appropriate cases
  • Assist in the coordination of care across a variety of settings (hospitals, outpatient clinics, home care, DME vendors, dialysis) while maintaining strict confidentiality & the highest level of professionalism
  • Coordinate DME/Therapies for members by obtaining scripts/clinicals for FAD requests by reaching out to members/providers/vendors. 
  • Obtain prescriptions & clinical documents from providers to assist members with obtaining care (e.g surgeries/hospital stay)
  • Set up contract with appropriate vendors (Optum, Cigna)
  • Assist with finding in network options for care (BH/Optum, Medical, Transplant) 
  • Make/link appropriate tickets & follow through until resolution is complete (e.g Medops, Net, Benefits, FAD, Eligibility, Claims, Provider, Service)
  • Work collaboratively with facility Financial Coordinators
  • Send HIPAA authorization requests & other documents to facilities/hospitals to assist in guiding members INN
  • Escalate issues as needed for additional support (Case Manager, Concierge Expert, Lead)
  • Other tasks, as needed, to support Case Manager & the department 

Requirements:

  • 6+ Months of Customer Service and/or previous healthcare experience
  • Intermediate or advanced computer literacy skills 

Bonus points:

  • Associate Degree
  • Bilingual (English/Spanish) 

Life at Oscar: 

Our more than 1,000 employees aim to make health care affordable & accessible for all. We apply this same vision to our perks & benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.

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 your unique background & perspectives.

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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