Hi, we're Oscar. We're hiring a Senior Analyst, Data Analytics, SIU to join our SIU team.

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.

About the role:

The Senior Analyst, Data Analytics, SIU partners across the organization to manage inefficiencies in the business. You will support teams in scoping, analyzing and monitoring performance of important financial and utilization metrics in service of our goals. The Senior Analyst, Data Analytics collaborates independently with stakeholders to define key questions and scope analyses. They may at times be called upon to speak to prepared analysis both internally and externally. This work aims to reduce medical waste and deliver more affordable and higher-quality health care for Oscar's members.

You will report into the Manager, SIU Data Analytics & Reporting.

Work Location: This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia. 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.

If you live within commutable distance to our New York City office (in Hudson Square) or our Tempe office (off the 101 at University Ave), you will be expected to come into the office at least three days each week. Otherwise, this is a remote / work-from-home role.  Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. 

Pay Transparency: The base pay for this role in the states of New Jersey and New York is: $86,628 - $109,761 per year. The base pay for this role in all other locations is: $75,265 - $98,785 per year.  You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

You must be currently authorized to work in the United States on a full-time basis. Oscar will not sponsor applicants for this role.

Responsibilities:

• Analyze data to support business teams in making better informed, data-driven decisions
• Use data to tell a story that non-technical colleagues can understand, including packaging and presenting findings in a clear, concise and compelling manner
• Oversee the creation and maintenance of essential operational and analytical dashboards, and update and enhance them as our user's needs evolve
• Create models and tools that produce relevant insights to identify inefficiencies and generate insights to remove inefficiencies
• Collaborate across the organization to identify actions to achieve improvements and monitor initiative impact
• Support other strategic projects as assigned to meet business needs
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 1+ years of technical work experience using analytical tools and writing analytical reports
• 1+ years demonstrated ability to work with large datasets and distill analyses into relevant insights with a structured and systematic thought process
• Strong communication skills, verbal and written, around business reporting impact and requirements, as demonstrated by experience on at least 2 reporting projects requiring communication between technical and non-technical users
• Experience in SQL, with the ability to filter, aggregate, and build CTEs, or proficiency in R or Python, including experience with Pandas, for loops, and statistical tests
• Proficiency in Google Sheets or Excel skills, with ability to use VLookup, nested if statements and connected Sheets
• 1+ years experience in healthcare, finance or the insurance industry

Bonus points:

• 1+ years experience in preparing healthcare analytics and reporting
• 1+ years experience managing value-based contracts at a payer or a provider organization (ACO, CIN, MSO)
• 1+ years experience developing dashboards and working with Looker, or other business intelligence/data visualization tools
• Exposure to healthcare contract negotiations, risk adjustment, ACA marketplace, quality of care, and/or population health experience

Hi, we're Oscar. We're hiring a Senior Analyst, Regulatory Operations to join our Regulatory team.

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.

About the role:

The Sr. Regulatory Analyst is an important member of the Regulatory Operations team responsible for project managing and supporting discrete tasks to ensure Oscar is compliant with federal and state product filing requirements. You will work with internal Oscar teams and interfaces with our external regulators.

You will report into the Senior Manager, Regulatory Operations.

Work Location: This is a remote position, open to candidates who reside in: Arizona, California, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia. 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.

Pay Transparency: The base pay for this role in the states of New Jersey and New York is: $38.22 - $50.16 per hour. The base pay for this role for all other locations is: $34.39 - $45.14 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Manage the preparation and filing of Oscar's commercial insurance products through the annual Form & Binder Filings for assigned states and regions, serving as an advisor to teams
• Develop processes for internal tracking and monitoring annual and ad hoc filings with diverse teams, including maintaining a repository of previously received objections to decrease YOY objection totals
• Build and support successful relationships with regulatory bodies, including state insurance regulators (e.g., DMHC in California, Arizona Department of Insurance, Texas Department of Insurance), state-based exchanges (e.g., Covered California), and federal insurance regulators (CMS, CCIIO, etc.)
• Serve as a subject matter expert on assigned states and contribute to the development of a repository of internal procedural guides on annual filing obligations to support teams and retain institutional knowledge
• Track and share filing objections received and guide overall resolution together with impacted teams
• Develop sustainable processes which simplify our growing team's outputs while ensuring high quality deliverables
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Bachelor's degree or commensurate experience
• 1+ years of SERFF and HIOS experience
• Demonstrated project management skills

Bonus points:

• Familiarity with ACA marketplace plans, rules and regulations

Hi, we're Oscar. We're hiring an Associate, Delegate Oversight to join our Delegation Oversight team.

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.

About the role:

The Associate, Delegate Oversight supports the enterprise's compliance program and activities. You will assist in the development of all compliance program activities to ensure understanding of healthcare regulatory requirements. You will assess business unit compliance to laws, regulations, standards, and their procedures by conducting audit and monitoring activities.

You will report into the Sr. Manager, Compliance Audit and Monitoring.

Work Location: This is a remote position, open to candidates who reside in: Dallas, TX. 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

Pay Transparency: The base pay for this role is: $87,188 - $114,434 per year. You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year and annual performance bonuses.

Responsibilities:

• Help create a risk-based audit and monitoring plan for the healthcare organization.
• Review healthcare regulations, including HIPAA, Medicare, Medicaid and NCQA regulations to ensure compliance.
• Conduct assigned audits based on departmental audit plans.
• Partner with teams to understand their business operations and test their compliance with regulations.
• Evaluate compliance effectiveness and identify areas for improvement.
• Draft and complete accurate audit reports, ensuring that the audit findings and conclusions are communicated to the business unit.
• Help identify compliance gaps and risks, and contribute to the development of proactive strategies to address them.
• Help maintain compliance policies, procedures, and controls with regulatory requirements.
• Provide regular updates to leadership on compliance audit and monitoring activities and recommendations.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Bachelor's Degree or equivalent work experience
• 3+ years experience working in health care or related field
• 3+ years experience in health plan compliance
• 3+ years driving compliance with regulatory and accreditation audit/policy requirements
• 3+ years experience working with regulation and translating into operational procedures
• 3+ years experience / background in a fast-paced environment

Bonus points:

• Certification in Healthcare Compliance (CHC), Certified Compliance and Ethics Professional CCEP, or similar
• Fluency with State DOI audit and/or reporting obligations
• State DOI audit management experience
• Experience in a start-up and/or health tech environment
• Experience in a TPA setting

Hi, we're Oscar. We're hiring an Associate, Delegate Oversight to join our Delegation Oversight team.

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.

About the role:

The Associate, Delegate Oversight supports the enterprise's compliance program and activities. You will assist in the development of all compliance program activities to ensure understanding of healthcare regulatory requirements. You will assess business unit compliance to laws, regulations, standards, and their procedures by conducting audit and monitoring activities.

You will report into the Sr. Manager, Compliance Audit and Monitoring.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, GA. 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

Pay Transparency: The base pay for this role is: $87,188 - $114,434 per year. You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year and annual performance bonuses.

Responsibilities:

• Help create a risk-based audit and monitoring plan for the healthcare organization.
• Review healthcare regulations, including HIPAA, Medicare, Medicaid and NCQA regulations to ensure compliance.
• Conduct assigned audits based on departmental audit plans.
• Partner with teams to understand their business operations and test their compliance with regulations.
• Evaluate compliance effectiveness and identify areas for improvement.
• Draft and complete accurate audit reports, ensuring that the audit findings and conclusions are communicated to the business unit.
• Help identify compliance gaps and risks, and contribute to the development of proactive strategies to address them.
• Help maintain compliance policies, procedures, and controls with regulatory requirements.
• Provide regular updates to leadership on compliance audit and monitoring activities and recommendations.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Bachelor's Degree or equivalent work experience
• 3+ years experience working in health care or related field
• 3+ years experience in health plan compliance
• 3+ years driving compliance with regulatory and accreditation audit/policy requirements
• 3+ years experience working with regulation and translating into operational procedures
• 3+ years experience / background in a fast-paced environment

Bonus points:

• Certification in Healthcare Compliance (CHC), Certified Compliance and Ethics Professional CCEP, or similar
• Fluency with State DOI audit and/or reporting obligations
• State DOI audit management experience
• Experience in a start-up and/or health tech environment
• Experience in a TPA setting

Hi, we're Oscar. We're hiring an Associate, Delegate Oversight to join our Delegation Oversight team.

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.

About the role:

The Associate, Delegate Oversight supports the enterprise's compliance program and activities. You will assist in the development of all compliance program activities to ensure understanding of healthcare regulatory requirements. You will assess business unit compliance to laws, regulations, standards, and their procedures by conducting audit and monitoring activities.

You will report into the Sr. Manager, Compliance Audit and Monitoring.

Work Location: This position is based in our Tempe, AZ office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid

Pay Transparency: The base pay for this role is: $87,188 - $114,434 per year. You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year and annual performance bonuses.

Responsibilities:

• Help create a risk-based audit and monitoring plan for the healthcare organization.
• Review healthcare regulations, including HIPAA, Medicare, Medicaid and NCQA regulations to ensure compliance.
• Conduct assigned audits based on departmental audit plans.
• Partner with teams to understand their business operations and test their compliance with regulations.
• Evaluate compliance effectiveness and identify areas for improvement.
• Draft and complete accurate audit reports, ensuring that the audit findings and conclusions are communicated to the business unit.
• Help identify compliance gaps and risks, and contribute to the development of proactive strategies to address them.
• Help maintain compliance policies, procedures, and controls with regulatory requirements.
• Provide regular updates to leadership on compliance audit and monitoring activities and recommendations.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Bachelor's Degree or equivalent work experience
• 3+ years experience working in health care or related field
• 3+ years experience in health plan compliance
• 3+ years driving compliance with regulatory and accreditation audit/policy requirements
• 3+ years experience working with regulation and translating into operational procedures
• 3+ years experience / background in a fast-paced environment

Bonus points:

• Certification in Healthcare Compliance (CHC), Certified Compliance and Ethics Professional CCEP, or similar
• Fluency with State DOI audit and/or reporting obligations
• State DOI audit management experience
• Experience in a start-up and/or health tech environment
• Experience in a TPA setting

Hi, we're Oscar. We're hiring an Associate, Delegate Oversight to join our Delegation Oversight team.

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.

About the role:

The Associate, Delegate Oversight supports the enterprise's compliance program and activities. You will assist in the development of all compliance program activities to ensure understanding of healthcare regulatory requirements. You will assess business unit compliance to laws, regulations, standards, and their procedures by conducting audit and monitoring activities.

You will report into the Sr. Manager, Compliance Audit and Monitoring.

Work Location: This position is based in our New York City office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid

Pay Transparency: The base pay for this role is: $96,876 - $127,149 per year. You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year and annual performance bonuses.

Responsibilities:

• Help create a risk-based audit and monitoring plan for the healthcare organization.
• Review healthcare regulations, including HIPAA, Medicare, Medicaid and NCQA regulations to ensure compliance.
• Conduct assigned audits based on departmental audit plans.
• Partner with teams to understand their business operations and test their compliance with regulations.
• Evaluate compliance effectiveness and identify areas for improvement.
• Draft and complete accurate audit reports, ensuring that the audit findings and conclusions are communicated to the business unit.
• Help identify compliance gaps and risks, and contribute to the development of proactive strategies to address them.
• Help maintain compliance policies, procedures, and controls with regulatory requirements.
• Provide regular updates to leadership on compliance audit and monitoring activities and recommendations.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Bachelor's Degree or equivalent work experience
• 3+ years experience working in health care or related field
• 3+ years experience in health plan compliance
• 3+ years driving compliance with regulatory and accreditation audit/policy requirements
• 3+ years experience working with regulation and translating into operational procedures
• 3+ years experience / background in a fast-paced environment

Bonus points:

• Certification in Healthcare Compliance (CHC), Certified Compliance and Ethics Professional CCEP, or similar
• Fluency with State DOI audit and/or reporting obligations
• State DOI audit management experience
• Experience in a start-up and/or health tech environment
• Experience in a TPA setting

Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team.

Oscar is the first health insurance company built around a full stack technology platform and a 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.

About the role

The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations.

You will report to the Manager, SIU Coding Audit.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Responsibilities

• Develop a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements.
• Perform complex audits of assigned medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar.
• Document findings including reference to sources used to support decision making and in a way that can be easily understood by non clinicians or coders.
• Create audit report findings, tools, and reference guide that can be used by other team members to communicate findings or more effectively perform similar reviews.
• Help draft written communications to providers to convey audit findings.
• Participate in educational calls with providers.
• Help train new team members.
• Develop and document processes to improve the effectiveness of the team.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 2+ years of coding or auditing experience across multiple specialties is required
• Bachelor's degree or 4+ years of work experience
• Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC) designation or similar certification
• Experience working in production-based environment
• Experience of both outpatient and inpatient auditing

Bonus Points

• Certified Professional Medical Auditor (CPMA)
• Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), other coding certifications or similar
• Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
• Demonstrated experience translating technical jargon to non-technical end users.
• Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting.
• Experience with HIPAA, data privacy, and/or data security processes
• Experience working with regulators governing (public or private) health insurance carriers

Hi, we're Oscar. We're hiring a SIU Investigator to join our SIU team.

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.

About the role:

The SIU Investigator identifies and investigates aberrant behavior observed in medical claims data and member enrollment data. You will manage an investigative caseload from case identification through to resolution, including data mining, investigation planning, data analysis, sampling, medical records requests, audit interpretation, overpayment recovery, reporting to regulatory agencies and monitoring ongoing provider behavior. The Senior Analyst will meet metrics set forth related to caseload, turn around times, and other unit-wide goals.

You will report into the Investigations Manager, SIU.

Work Location: This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia. 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.

If you live within commutable distance to our New York City office (in Hudson Square) or our Tempe office (off the 101 at University Ave), you will be expected to come into the office at least three days each week. Otherwise, this is a remote / work-from-home role.  Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. 

The base pay for this role in the states of New Jersey and New York is: $72,036 - $94,546 per year. The base pay for this role in all other locations is: $64,832 - $85,092 per year.  You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Identify and conduct investigations into suspected FWA with high autonomy
• Document findings to include formal investigative reports, tables, graphs, audit logs, and other supporting documentation
• Met metrics to align with caseload, turn around times, and other unit-wide goals
• Continue to monitor providers with substantiated findings to track behavior change
• Participate in the development and presentation of FWA-related education for Oscar teams
• Build evidentiary files for potential recovery, legal action, and/or referrals to appropriate outside agencies
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies
• 3+ year experience with applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity

Bonus points:

• Bachelor's degree in Criminal Justice or a related field
• Experience with HIPAA, data privacy, and/or data security processes
• Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar
• Certified Professional Coder (CPC) or similar