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Oscar Health // health insurance
 
Remote    Posted: Tuesday, August 03, 2021
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring a Process Optimization Associate to join our SIU Team. 

Oscar is the first health insurance company built around a full stack technology platform & a relentless 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 SIU runs or coordinates activities across Oscar to reduce the incidence & impact of fraud, waste, and/or abuse (FWA) on all our operations. 

Your primary role will be to support Oscar in its fight against fraud.  Joining this dynamic team will expose you to the latest trends & patterns in FWA across the healthcare industry & provide you with the chance to fight FWA by improving the process & efficiencies of the work performed by the SIU team.  Your work will not only lead to increased savings & recoupments for Oscar as a company, but to more affordable & higher-quality health care for the members we serve.

You will report into the Director, SIU, who reports to the Compliance Officer.

This is a remote role, you will work remotely in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.

Primary Duties & Responsibilities 

  • Build an understanding of relevant policies & workflows performed within the SIU including Prepay Review, Post-pay Claims Re-Adjudication, Provider Disputes, Overpayment Recovery & Application, Medical Record Requests/Retrieval, Document Storage, Post Pay Investigation Case Flow, Member Rescission, FWA Training Delivery, Regulator Reporting, & more.

  • Create & maintain documents that demonstrate these workflows including identifying touchpoints & interactions with multiple other departments and/or vendors

  • Identify opportunities for workflow improvements within the SIU & at identified cross divisional touchpoints

  • Continuously improve existing workflows including partnering with other departments to execute

  • Find & implement automation opportunities, document & measure the impact of the improvements

  • Become well-acquainted with internal tools used within multiple other departments to see how they can be leveraged for SIU

  • Create & deliver education or communication (depending on the level of impact)  to other areas of the organization when it is identified that a process flow update will impact their area

  • Form a working relationship with all partners across the organization including but not limited to: Data, PI, SIU, Finance, P&L, L&D, Concierge, & Enrollment

Required education & experience

  • Bachelor's degree or 4+ years of related work experience in analytics or supply chain

  • 4+ years of professional experience

  • Experience using & building Lean processes / Six Sigma methodologies

  • Experience in SQL, Python, or similar database languages 

Preferred education & experience/Bonus Points

  • Certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] & Fraud Professional (CAFP), other coding certifications or similar

  • Six Sigma or Lean Certifications

  • Knowledge of applicable fraud statutes & regulations, & of federal guidelines on recoupments & other anti-FWA activity

  • Experience working in health insurance specifically with claims processing, billing, reimbursement, provider contracting, or enrollment.

  • Experience with HIPAA, data privacy, and/or data security processes

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.

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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