What is the Position?
In this role, you will work within Oscars Operations organization to build & improve upon Oscars adjudication infrastructure & underlying logic, playing a key role in the transition to a next generation technology platform for core insurance functions. You will be responsible for designing & implementing the rules that determine when & how to pay claims, for establishing integrations to enable Oscars entry into Medicare Advantage, & will work closely alongside Oscars Tech, Risk, & Network teams to connect your work into the broader Oscar ecosystem. Finally, you will be the owner of initiatives that will contribute to a unique provider & member experience & will be vital to supporting Oscars growing membership.
Youll work alongside the rest of the Insurance Operations team, Claims & Member Engineering, data scientists, & business leads to get your work done. Well expect you to understand complexity, distill it, & explain it in simple, structured terms.
Deliverables: What you have to achieve
During the first 6 weeks you have:
- Developed a thorough understanding of the operations ecosystem (including the underlying technology) as well as its current strengths, weaknesses, & gaps.
- Internalized the coding languages & data structures used in both older health industry systems & the next generation tech platform that Oscar is building.
- Begun to form a strong working relationship with internal & external stakeholders.
During the first 6 months you have:
- Independently built scripts & tools to ensure seamless data integrations between Oscars external partners & its new insurance technology stack.
- Become an expert on the rules & requirements of Medicare Advantage & its differences from Oscars current product offerings.
- Partnered closely with the Claims Engineering org to structure & operationalize the next generation of Claim & Member data.
On an ongoing basis you will:
- Build & oversee Claims & Member data integrations & accompanying technical projects for Oscars entrance into Medicare Advantage.
- Distill the requirements of new product & market expansions & design automated workflows to reduce manual work requirements.
- Support the Claims & Member configuration operations team to resolve provider & member escalations through issue investigation, training, & technical tooling.
What leads to success in this role?
Must-have qualities include:
- A bachelors degree
- A technical bend & the ability to use tools to answer your own questions (e.g. SQL/Python)
- Outstanding structured, systematic, & critical thinking
- A passion for distilling complex concepts & workflows into clear, concise content
- A demonstration of deep analytical skills
- A strong desire to follow through ideas until you implement them in reality
- 2-4 years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering)
We think it will make a big (positive) difference if you have...
- An academic & professional background in coding, math, statistics, or data science
- Knowledge & passion of healthcare and/or health insurance
- Insatiable curiosity of subject matter & a desire to seek the truth
- Knowledge management, training, or content development experience
- A willingness to master the detail but also zoom out to understand the big picture
- Start-up experience
- An enjoyment experimenting & iterating on ways to solve a problem
We are an equal opportunity employer & value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.