Hi, we're Oscar. We're hiring an Associate, Provider Data Analytics to join our Provider Data Operations 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, Provider Data Analytics reviews provider data-related issues and scales solutions through impact analysis. We are looking for collaboration with business and technical stakeholders to represent departmental needs in company-wide strategic initiatives and problem-solving. Key responsibilities include understanding business requirements, building and managing project plans, documenting decisions, and developing risk mitigation and change management strategies.

You will report into the Senior Manager, Provider Data Operations.

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: $96,876.00 - $127,149.75 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Leads end-to-end management of cross-functional projects related to provider data issues, including issue analysis, stakeholder engagement, coordination of cross-functional relationships to drive collaboration, and participation in testing to ensure accurate and effective solutions
• Collaborates with internal and external stakeholder groups to develop proactive solution plans for data issues, including communication strategies and program initiatives for successful change management and risk mitigation
• Identifies trends in provider data issues and scale solutions by leveraging various analytics to assess the overall impact
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 3+ years commensurate experience
• 3+ years of work experience in operations, health insurance, data analysis, and/or consulting
• 2+ years of experience using SQL and Excel
• 2+ years of experience with end to end project management
• 2+ years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures
• 2+ years of experience with process improvement methodologies such as Lean, Six Sigma

Bonus points:

• Bachelor's degree in Engineering, Business Administration, or other related field
• Lean Six Sigma Green Belt certification or higher

Hi, we're Oscar. We're hiring an Associate, Provider Data Analytics to join our Provider Data Operations 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, Provider Data Analytics reviews provider data-related issues and scales solutions through impact analysis. We are looking for collaboration with business and technical stakeholders to represent departmental needs in company-wide strategic initiatives and problem-solving. Key responsibilities include understanding business requirements, building and managing project plans, documenting decisions, and developing risk mitigation and change management strategies.

You will report into the Senior Manager, Provider Data Operations.

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: $87,188.40 - $114,434.78 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Leads end-to-end management of cross-functional projects related to provider data issues, including issue analysis, stakeholder engagement, coordination of cross-functional relationships to drive collaboration, and participation in testing to ensure accurate and effective solutions
• Collaborates with internal and external stakeholder groups to develop proactive solution plans for data issues, including communication strategies and program initiatives for successful change management and risk mitigation
• Identifies trends in provider data issues and scale solutions by leveraging various analytics to assess the overall impact
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 3+ years commensurate experience
• 3+ years of work experience in operations, health insurance, data analysis, and/or consulting
• 2+ years of experience using SQL and Excel
• 2+ years of experience with end to end project management
• 2+ years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures
• 2+ years of experience with process improvement methodologies such as Lean, Six Sigma

Bonus points:

• Bachelor's degree in Engineering, Business Administration, or other related field
• Lean Six Sigma Green Belt certification or higher

Hi, we're Oscar. We're hiring an Associate, Provider Data Analytics to join our Provider Data Operations 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, Provider Data Analytics reviews provider data-related issues and scales solutions through impact analysis. We are looking for collaboration with business and technical stakeholders to represent departmental needs in company-wide strategic initiatives and problem-solving. Key responsibilities include understanding business requirements, building and managing project plans, documenting decisions, and developing risk mitigation and change management strategies.

You will report into the Senior Manager, Provider Data Operations.

Work Location: This is a remote position, open to candidates who reside in: Dallas, Texas. 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: $87,188.40 - $114,434.78 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Leads end-to-end management of cross-functional projects related to provider data issues, including issue analysis, stakeholder engagement, coordination of cross-functional relationships to drive collaboration, and participation in testing to ensure accurate and effective solutions
• Collaborates with internal and external stakeholder groups to develop proactive solution plans for data issues, including communication strategies and program initiatives for successful change management and risk mitigation
• Identifies trends in provider data issues and scale solutions by leveraging various analytics to assess the overall impact
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 3+ years commensurate experience
• 3+ years of work experience in operations, health insurance, data analysis, and/or consulting
• 2+ years of experience using SQL and Excel
• 2+ years of experience with end to end project management
• 2+ years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures
• 2+ years of experience with process improvement methodologies such as Lean, Six Sigma

Bonus points:

• Bachelor's degree in Engineering, Business Administration, or other related field
• Lean Six Sigma Green Belt certification or higher

Hi, we're Oscar. We're hiring an Associate, Provider Data Analytics to join our Provider Data Operations 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, Provider Data Analytics reviews provider data-related issues and scales solutions through impact analysis. We are looking for collaboration with business and technical stakeholders to represent departmental needs in company-wide strategic initiatives and problem-solving. Key responsibilities include understanding business requirements, building and managing project plans, documenting decisions, and developing risk mitigation and change management strategies.

You will report into the Senior Manager, Provider Data Operations.

Work Location: This position is based in our Tempe, Arizona 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: $87,188.40 - $114,434.78 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Leads end-to-end management of cross-functional projects related to provider data issues, including issue analysis, stakeholder engagement, coordination of cross-functional relationships to drive collaboration, and participation in testing to ensure accurate and effective solutions
• Collaborates with internal and external stakeholder groups to develop proactive solution plans for data issues, including communication strategies and program initiatives for successful change management and risk mitigation
• Identifies trends in provider data issues and scale solutions by leveraging various analytics to assess the overall impact
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 3+ years commensurate experience
• 3+ years of work experience in operations, health insurance, data analysis, and/or consulting
• 2+ years of experience using SQL and Excel
• 2+ years of experience with end to end project management
• 2+ years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures
• 2+ years of experience with process improvement methodologies such as Lean, Six Sigma

Bonus points:

• Bachelor's degree in Engineering, Business Administration, or other related field
• Lean Six Sigma Green Belt certification or higher

Hi, we're Oscar. We're hiring a Sr. Specialist, Credentialing to join our Provider Operations 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:

You will solve complex issues or concerns impacting our provider credentialing process. You will act as a subject matter expert for credentialing. You will work cross functionally between teams across Oscar. You will track and trend provider and facility credentialing issues and partner with stakeholders to resolve escalated issues. You will support process improvement processes for the credentialing team.

You will report into the Manager, Provider Credentialing.

Work Location: This is a remote position, open to candidates who reside in: Alabama; Arizona; Arkansas; Colorado; Connecticut; District of Columbia; Florida; Georgia; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Maine; Maryland; Massachusetts; Michigan; Minnesota; Missouri; Nevada; New Hampshire; New Jersey; New Mexico; North Carolina; Ohio; Oregon; Pennsylvania; Rhode Island; South Carolina; Tennessee; Texas; Utah; Vermont; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The hourly pay for this role is: $24.00/hr. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Support, manage, or escalate complex issues that are not solved using conventional workflows.
• Effectively manage internal or external escalated transactions and communicate with appropriate parties for effective resolution in adherence to SLAs
• Act as a point person for stakeholders in other areas of the business to improve feedback loops and trend facility and provider credentialing issues
• Manage queue work and and assigned caseload through efficient dashboard management
• Collaborate daily with production and credentialing leaders on systemic issues and communicate blockers to care and satisfaction
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 1+ years of credentialing experience for facilities, adhering to NCQA standards
• 2+ years previous work experience in a fast-paced volume-based environment
• 2+ years strong quantitative or analytical skills focused on proactively identifying or solving problems
• Experience working in health insurance

Bonus points:

• Bachelor's Degree
• High school diploma or GED
• 1+ years of credentialing experience for practitioners, adhering to NCQA standards
• Background in health insurance
• Proficiency with non Microsoft business platforms
• Proficiency in using a credentialing or provider data repository
• Primary Source Verification
• Experience with healthcare data such as provider data
• Strong verbal and written communications, and interpersonal interactions

Hi, we're Oscar. We're hiring a Senior Manager, Speciality / Ancillary Products to join our Insurance Product Development 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 Manager, Speciality / Ancillary Solutions is accountable for the strategy, design, execution and performance of the ancillary product portfolio, with a primary focus on dental and vision. This role owns the end-to-end lifecycle of ancillary insurance products including product strategy, regulatory execution, third party vendor implementation leadership and management post launch optimization across the individual market.

You will report into the Vice President, Insurance Product Innovation and Development

Work Location: This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Florida, Georgia, Illinois, Massachusetts, Michigan, Nevada, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, or Virginia. Note, this list of states is subject to change. #LI-Remote

Pay Transparency: The base pay for this role is: $149,040 - $195,615 per year in New Jersey, New York, and California. The base pay for all other locations is: $134,136 - $176,053 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

Ancillary Product Strategy & Portfolio Management

• In partnership with leader, drives the ancillary product strategy and roadmap across dental, vision and other ancillary offerings (e.g. hearing, fitness, over the counter benefits, wellness and other insurance add-on products)

• Owns the full end-to-end lifecycle of ancillary products, including dental and vision insurance offerings, from ideation and benefit design through launch, performance management, and ongoing optimization

• Build and manage business cases for new and existing products, including financial modeling, membership projections, and ongoing performance tracking against goals.

• Analyze product performance using financial and membership metrics to forecast results, identify risks and opportunities, and inform decision-making.

• Lead benefit design for ancillary products, including augmenting existing offerings, remediating underperforming designs, and introducing new benefit structures for specific consumer populations, based on performance, member needs, and market dynamics

• Contribute to annual planning, roadmap development, and prioritization for ancillary products

Vendor Implementation Lead & Management

• Business lead for end to end implementation of ancillary vendors, serving as the primary product DRI and escalation point for dental and vision vendors and provide oversight for ancillary vendors

• Define and manage vendor requirements, SLAs, KPIs and performance scorecards

• Partner with procurement, legal and compliance on vendor selection, contracting, renewals and performance governance

• Drive timely issue resolution and root cause remediation with vendors to prevent repeat issues

• Serves as a member of the Joint Operating Committee (JOC) for ancillary products, in partnership with Network, and leadership, including agenda setting, performance reviews, issue tracking, and follow-through on commitments

• Identify risks, gaps, and opportunities across benefit design, product performance, and execution, including recommendation of corrective actions

Execution, Filings & Regulatory Alignment

• Partner with Actuarial and Finance teams to evaluate pricing, unit economics, and profitability tradeoffs, to inform benefit and portfolio decisions

• Collaborate with Regulatory and Legal teams to ensure ancillary products comply with federal and state requirements and are filed, updated, and approved as needed

• Oversee ancillary product QA, attestations and final sign off prior to filing submissions

• Ensure compliance with all applicable laws, regulations, and internal governance standards

Cross Functional Leadership & Governance

• Act as the single accountable product owner for ancillary benefits- coordinating across teams

• Translate vendor capabilities and regulatory constraints into clear product requirements

• Influence senior leaders with clear data-driven recommendations and risk assessments

Post Launch Performance & Optimization

• Develop and maintain regular performance reporting and product look-backs, assessing financial, operational, clinical, and member experience outcomes

• Use analytics and business intelligence tools (e.g., Looker) to pull, analyze, and interpret data related to utilization, cost, engagement, retention, and vendor performance

• Carry forward learnings to future cycles to improve scalability, reduce risk and enhance member outcomes

Data Driven Decision Making

• Leverage enrollment, utilization, cost, quality and vendor performance data to inform ancillary product strategy

• Identify trends and risks early and proactively adjust product or vendor strategies

• Compliance with all applicable laws and regulations

• Other duties as assigned

Requirements:

• 6+ years of experience developing, managing, or supporting commercial insurance products, with direct ownership of ancillary (dental, vision, supplemental health) offerings, with Strong understanding of regulatory requirements impacting ancillary benefits 

• 5+ years of expertise in Dental and Vision product design and vendor implementation

• 4+ years of Proven experience managing delegated vendors and complex operational partnerships

• 4 + years experience with ACA, including individual market place and small group products

• 3+ years of experience with product lifecycle management for ancillary offerings

• 3+  years experience making data-driven decision and using business intelligence tools to analyze product performance

• Travel up to 25% of the time

Bonus points:

• Bachelor’s degree in business, healthcare, analytics, or related field

• Experience with ancillary insurance products (e.g., dental, vision, supplemental benefits)

• Proficiency with business intelligence tools, experience with SQL, Excel, or similar tools

• Experience supporting or participating in Joint Operating Committee or vendor governance forums

Hi, we're Oscar. We're hiring a Senior Analyst, Payment Integrity Disputes to join our Disputes 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:

You will be responsible for supporting payment integrity disputes and issue resolution in the Oscar claim environment for both the Oscar Insurance business. You will scope, triage, investigate and execute on solutions and process improvements. You will leverage a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally and understand and translate friction from stakeholders into actionable opportunities for improvement.

You will report into the Manager, Payment Integrity (Pre-Pay).

Work Location: This position is based in our Tempe, Arizona 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: $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:

• Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity disputes, internal claims processing edits and external vendor edits.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
• Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever leadership escalates and assigns issues.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Experience in Payment Integrity focused on Disputes and/or appeals
• 4+ years of experience in claims processing, coding, auditing or health care operations
• 3+ years experience in medical coding
• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
• Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
• 2+ years experience deriving business insights from datasets and solving problems
• 1+ years experience improving business workflows and processes
• 1+ years experience collaborating with internal and external stakeholders

Bonus points:

• 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)
• 2+ years of experience working with large data sets using excel or a database language
• Experience in a professional healthcare claims organization
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training
• Experience using SQL

Hi, we're Oscar. We're hiring a Senior Analyst, Payment Integrity Disputes to join our Disputes 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:

You will be responsible for supporting payment integrity disputes and issue resolution in the Oscar claim environment for both the Oscar Insurance business. You will scope, triage, investigate and execute on solutions and process improvements. You will leverage a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally and understand and translate friction from stakeholders into actionable opportunities for improvement.

You will report into the Manager, Payment Integrity (Pre-Pay).

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: $72,036 - $94,547 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity disputes, internal claims processing edits and external vendor edits.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
• Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever leadership escalates and assigns issues.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Experience in Payment Integrity focused on Disputes and/or appeals
• 4+ years of experience in claims processing, coding, auditing or health care operations
• 3+ years experience in medical coding
• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
• Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
• 2+ years experience deriving business insights from datasets and solving problems
• 1+ years experience improving business workflows and processes
• 1+ years experience collaborating with internal and external stakeholders

Bonus points:

• 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)
• 2+ years of experience working with large data sets using excel or a database language
• Experience in a professional healthcare claims organization
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training
• Experience using SQL

Hi, we're Oscar. We're hiring a Senior Analyst, Payment Integrity Disputes to join our Disputes 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:

You will be responsible for supporting payment integrity disputes and issue resolution in the Oscar claim environment for both the Oscar Insurance business. You will scope, triage, investigate and execute on solutions and process improvements. You will leverage a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally and understand and translate friction from stakeholders into actionable opportunities for improvement.

You will report into the Manager, Payment Integrity (Pre-Pay).

Work Location: 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

Pay Transparency: The base pay for this role 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:

• Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity disputes, internal claims processing edits and external vendor edits.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
• Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever leadership escalates and assigns issues.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Experience in Payment Integrity focused on Disputes and/or appeals
• 4+ years of experience in claims processing, coding, auditing or health care operations
• 3+ years experience in medical coding
• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
• Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
• 2+ years experience deriving business insights from datasets and solving problems
• 1+ years experience improving business workflows and processes
• 1+ years experience collaborating with internal and external stakeholders

Bonus points:

• 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)
• 2+ years of experience working with large data sets using excel or a database language
• Experience in a professional healthcare claims organization
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training
• Experience using SQL

Hi, we're Oscar. We're hiring a Senior Specialist, Coding Auditor to join our Payment Integrity.

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:

You will support issue resolution in the Oscar claim environment. You will be responsible for the end-to-end claims repayment quality, process improvement and supporting root cause analysis.

You will report into the VP, Payment Integrity.

Work Location: This is a remote position, open to candidates who reside in: Tempe, Arizona; Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; New York City, New York; Philadelphia, Pennsylvania; Salt Lake City, Utah. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role in New York City is: $65,412 - $85,853 per year. The base pay for this role in all other locations is: $58,870 - $77,267 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Develop and maintain a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements.
• Efficiently perform thorough and complex policy updates or audits of assigned documentation (i.e. medical records or claims) on both a prepayment and/or post payment basis to determine accuracy of claims submitted to Oscar.
• Explicitly 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 reports and reference guides that can be used by other team members to communicate findings or more effectively perform similar reviews.
• Assist in drafting written communications to providers to convey findings.
• Participate in educational calls with providers.
• Assist in the training of new team members.
• Develop and document processes to improve the efficiency and effectiveness of the team.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 1+ years of coding or auditing experience across multiple specialties.
• Certified Professional Coder (CPC) designation or similar certification
• Bachelor's degree or 4+ years of work experience
• Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting.

Bonus points:

• Certified Professional Medical Auditor
• Payment Integrity audit experience
• Demonstrated experience translating technical jargon to non-technical end users.
• 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 an Associate to join our Operational Controls 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 Associate, Operational Controls, in coordination with the Internal Controls Over Financial Reporting, supports the development, implementation and oversight of the operational control framework which includes meeting the requirements of Sarbanes Oxley (SOX), Model Audit Rule (MAR) and System & Organization Controls Report (SOC) requirements. The Associate documents operational processes, identifies, assesses and monitors the ongoing effectiveness of controls, support the development of corrective action plans and recommends improvement opportunities within Operations.

You will report to the Senior Manager, Operational Controls.

Work Location: This position is based in our Tempe, Arizona 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: $91,659 - $120,303 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Partner with the business to document business processes, risks and corresponding controls within areas of responsibility
• Advise control owners on the development, assess the quality and monitor the execution of assigned operational controls
• Advise remediation owners on the development, monitors progress and evaluates effectiveness of corrective action plans; follows department escalation procedures when necessary
• Consults on the development and implementation of clear, scalable and dynamic operational processes
• Manages and maintain relationships with relevant stakeholders and provides ongoing education around risk and controls
• Coordinates and participates in discussions between internal/external auditors and Operations.
• Adheres to departmental performance standards and offers suggestions on enhancing or improving departmental performance.
• Works with business owners in gathering evidence for control reviews; and assesses the quality of the evidence prior to uploading to relevant platforms
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 3+ years of experience in internal controls, operations and/or consulting
• 1+ years experience supporting strategic improvements in process and controls

Bonus Points

• Bachelor's degree
• Health insurance industry experience
• SOX, MAR and/or SOC1 experience
• Experience coordinating activities with internal and external parties

Hi, we're Oscar. We're hiring a Senior Analyst to join our Payment Integrity 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:

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 Senior Analyst, 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.

You will report into the Sr. Manager, Payment Integrity.

Work Location: 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

Pay Transparency: The base pay for this role 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:

• Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
• Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 4+ years of commensurate experience
• 3+ years of experience in claims processing, coding, auditing or health care claims operations
• 3+ years experience in medical coding within payment integrity
• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
• Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
• 2+ years experience deriving business insights from datasets and solving problems
• 1+ years experience improving business workflows and processes
• 1+ years experience collaborating with internal and/or external stakeholders

Bonus points:

• 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)
• Process Improvement or Lean Six Sigma training
• Experience using SQL

Hi, we're Oscar. We're hiring a SVP, Network & Provider Management to join our Insurance 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 SVP, Network & Provider Management leader is a key player in Oscar’s mission to enhance the quality and accessibility of care for members while supporting the organization's strategic goals. This role is directly responsible for crafting the overall network strategy, analyzing network adequacy and performance, articulating the engagement and experience standards for Oscar’s providers, providing the necessary tooling to manage network build and maintenance while ensuring compliance with regulatory requirements. This role supports the development and management of Oscar Health Insurance’s provider networks and contract negotiations, and leads a variety of network operations. This leader is key to ensuring Oscar meets its company goals and while providing network insights to support the line of business strategies.

You will report into the EVP. President of Oscar Insurance

Work Location: This position is based in our New York 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: $319,608 - $419,107 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities:

• Support Market leaders with network tooling, adequacy standards and contracting strategies
• Develop long-term strategies for network growth and optimization, addressing gaps in service coverage, and ensuring that the network adapts to changing healthcare trends and member needs.
• Utilize market trends and data to inform network strategy and identify opportunities for growth and improvement
• Ensure the development and maintenance of a comprehensive provider network, including hospitals, physicians, and ancillary providers.
• Demonstrating shared leadership in the overall insurance business by balancing the need to provide a broad network of services with controlling costs for both the company and policyholders through strong unit cost guidelines and contracting parameters.
• Monitor network adequacy and compliance with regulatory requirements.
• Monitor and evaluate network performance, addressing gaps and opportunities for improvement.
• Provide central management of contract inventory, renewals and amendments, ensuring all agreements are up-to-date and compliant with organizational policies and regulations.
• Provide guidance and support in contract negotiations and network management.
• Lead a variety of provider operations such as credentialing, contract configuration and provider data management
• Ensure a cohesive provider experience through leadership of provider success, provider communications, and provider marketing.  This includes partnering with Provider Relations and other operational areas such as Claims.
• Collaborate with other departments, such as sales, marketing, and operations, to align network strategy with organizational goals.
• Partner with technology to develop necessary tools and processes to manage Oscar’s networks.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 20+ years experience in provider contracting, network management, or a related field within the healthcare or health insurance industry.
• 10+ years experience leading in matrixed organizations
• 10+ years experience building systems and processes to support provider network operations, from the ground up

Bonus points:

• Experience partnering with technology teams to optimize and evolve operational programs
• Demonstrated success in growing provider networks

Hi, we're Oscar. We're hiring an Associate to join our Operational Controls 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 Associate, Operational Controls, in coordination with the Internal Controls Over Financial Reporting, supports the development, implementation and oversight of the operational control framework which includes meeting the requirements of Sarbanes Oxley (SOX), Model Audit Rule (MAR) and System & Organization Controls Report (SOC) requirements. The Associate documents operational processes, identifies, assesses and monitors the ongoing effectiveness of controls, support the development of corrective action plans and recommends improvement opportunities within Operations.

You will report to the Senior Manager, Operational Controls.

Work Location:

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: $101,844 - $133,670 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Partner with the business to document business processes, risks and corresponding controls within areas of responsibility
• Advise control owners on the development, assess the quality and monitor the execution of assigned operational controls
• Advise remediation owners on the development, monitors progress and evaluates effectiveness of corrective action plans; follows department escalation procedures when necessary
• Consults on the development and implementation of clear, scalable and dynamic operational processes
• Manages and maintain relationships with relevant stakeholders and provides ongoing education around risk and controls
• Coordinates and participates in discussions between internal/external auditors and Operations.
• Adheres to departmental performance standards and offers suggestions on enhancing or improving departmental performance.
• Works with business owners in gathering evidence for control reviews; and assesses the quality of the evidence prior to uploading to relevant platforms
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 3+ years of experience in internal controls, operations and/or consulting
• 1+ years experience supporting strategic improvements in process and controls

Bonus Points

• Bachelor's degree
• Health insurance industry experience
• SOX, MAR and/or SOC1 experience
• Experience coordinating activities with internal and external parties

Hi, we're Oscar. We're hiring an Associate to join our Operational Controls 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 Associate, Operational Controls, in coordination with the Internal Controls Over Financial Reporting, supports the development, implementation and oversight of the operational control framework which includes meeting the requirements of Sarbanes Oxley (SOX), Model Audit Rule (MAR) and System & Organization Controls Report (SOC) requirements. The Associate documents operational processes, identifies, assesses and monitors the ongoing effectiveness of controls, support the development of corrective action plans and recommends improvement opportunities within Operations.

You will report to the Senior Manager, Operational Controls.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia. 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: $91,659 - $120,303 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Partner with the business to document business processes, risks and corresponding controls within areas of responsibility
• Advise control owners on the development, assess the quality and monitor the execution of assigned operational controls
• Advise remediation owners on the development, monitors progress and evaluates effectiveness of corrective action plans; follows department escalation procedures when necessary
• Consults on the development and implementation of clear, scalable and dynamic operational processes
• Manages and maintain relationships with relevant stakeholders and provides ongoing education around risk and controls
• Coordinates and participates in discussions between internal/external auditors and Operations.
• Adheres to departmental performance standards and offers suggestions on enhancing or improving departmental performance.
• Works with business owners in gathering evidence for control reviews; and assesses the quality of the evidence prior to uploading to relevant platforms
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 3+ years of experience with internal controls, operations and/or consulting
• 1+ years experience supporting strategic improvements in process and controls

Bonus Points

• Bachelor's degree
• Health insurance industry experience
• SOX, MAR and/or SOC1 experience
• Experience coordinating activities with internal and external parties

Hi, we're Oscar. We're hiring a Senior Analyst to join our Payment Integrity 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:

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 Senior Analyst, 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.

You will report into the Sr. Manager, Payment Integrity.

Work Location: This position is based in our Tempe, Arizona 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: $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:

• Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
• Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 4+ years of commensurate experience
• 3+ years of experience in claims processing, coding, auditing or health care claims operations
• 3+ years experience in medical coding within payment integrity
• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
• Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
• 2+ years experience deriving business insights from datasets and solving problems
• 1+ years experience improving business workflows and processes
• 1+ years experience collaborating with internal and/or external stakeholders

Bonus points:

• 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)
• Process Improvement or Lean Six Sigma training
• Experience using SQL

Hi, we're Oscar. We're hiring an Associate to join our Operational Controls 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 Associate, Operational Controls, in coordination with the Internal Controls Over Financial Reporting, supports the development, implementation and oversight of the operational control framework which includes meeting the requirements of Sarbanes Oxley (SOX), Model Audit Rule (MAR) and System & Organization Controls Report (SOC) requirements. The Associate documents operational processes, identifies, assesses and monitors the ongoing effectiveness of controls, support the development of corrective action plans and recommends improvement opportunities within Operations.

You will report to the Senior Manager, Operational Controls.

Work Location: This is a remote position, open to candidates who reside in: Dallas, Texas. 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: $91,659 - $120,303 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Partner with the business to document business processes, risks and corresponding controls within areas of responsibility
• Advise control owners on the development, assess the quality and monitor the execution of assigned operational controls
• Advise remediation owners on the development, monitors progress and evaluates effectiveness of corrective action plans; follows department escalation procedures when necessary
• Consults on the development and implementation of clear, scalable and dynamic operational processes
• Manages and maintain relationships with relevant stakeholders and provides ongoing education around risk and controls
• Coordinates and participates in discussions between internal/external auditors and Operations.
• Adheres to departmental performance standards and offers suggestions on enhancing or improving departmental performance.
• Works with business owners in gathering evidence for control reviews; and assesses the quality of the evidence prior to uploading to relevant platforms
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 3+ years of experience in internal controls, operations and/or consulting
• 1+ years experience supporting strategic improvements in process and controls

Bonus Points

• Bachelor's degree
• Health insurance industry experience
• SOX, MAR and/or SOC1 experience
• Experience coordinating activities with internal and external parties

Hi, we're Oscar. We're hiring a Senior Analyst to join our Payment Integrity 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:

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 Senior Analyst, 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.

You will report into the Sr. Manager, Payment Integrity.

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: $72,036 - $94,547 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
• Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 4+ years of commensurate experience
• 3+ years of experience in claims processing, coding, auditing or health care claims operations
• 3+ years experience in medical coding within payment integrity
• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
• Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
• 2+ years experience deriving business insights from datasets and solving problems
• 1+ years experience improving business workflows and processes
• 1+ years experience collaborating with internal and/or external stakeholders

Bonus points:

• 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)
• Process Improvement or Lean Six Sigma training
• Experience using SQL