<p>Hi, we're Oscar. We're hiring an Associate to join our Payment Integrity team.</p> <p>Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.</p> <p><strong>About the role:</strong></p> <p>This role is responsible for supporting process improvement and issue resolution in the Oscar claim environment for both the Oscar Insurance business and +Oscar clients. The Associate, Payment Integrity role organizes, scopes, prepares, investigates and/or executes on solutions and process improvements within edits and ideation. This is accomplished by leveraging a deep understanding of Oscar’s claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement. </p> <p>You will report into the Senior Manager, Payment Integrity.</p> <p><strong>Work Location: </strong>This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote</p> <p><strong>Pay Transparency: </strong>The base pay for this role is: $82,717 - $108,566 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.</p> <p><strong>Responsibilities:</strong></p> <ul> <li>Provide subject matter expertise and in-depth understanding of Payment Integrity internal claims processing edits, external vendor edits and Oscar reimbursement policies.</li> <li>Respond to internal and external inquiries and disputes regarding policies and edits.</li> <li>Document industry standard coding rules and provide recommendations on reimbursement policy language and scope.</li> <li>Ideate payment integrity opportunities based on a deep knowledge of industry standard coding rules. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.</li> <li>Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.</li> <li>Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.</li> <li>Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate. </li> <li>Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership. </li> <li>Compliance with all applicable laws and regulations</li> <li>Other duties as assigned</li> </ul> <p><strong>Requirements:</strong></p> <ul> <li>A bachelor’s degree or 4+ years of commensurate experience </li> <li>4+ years of experience in claims processing, coding, auditing or health care operations</li> <li>4+ years experience in medical coding within payment integrity </li> <li>Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)</li> <li>Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.</li> <li>2+ years experience deriving business insights from datasets and solving problems </li> <li>1+ years experience improving business workflows and processes</li> <li>1+ years experience collaborating with internal and/or external stakeholders</li> </ul> <p><strong>Bonus points:</strong></p> <ul> <li>2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)</li> <li>Process Improvement or Lean Six Sigma training</li> <li>Experience using SQL</li> </ul><div class="content-conclusion"><p><span style="font-weight: 400;">This is an authentic Oscar Health job opportunity.</span></p> <p><span style="font-weight: 400;">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 and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.</span></p> <p><strong>Pay Transparency: </strong><span style="font-weight: 400;">Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. </span><span style="font-weight: 400;">Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.</span><