Hi, we're Oscar. We're hiring a Prior Authorization Pharmacy Technician to join our Pharmacy Tech 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 dedicated to high quality pharmacy decision-making and improving the member and provider experience. This position is responsible for processing prior authorizations requests and providing support for escalated issues related to prior authorizations.

You will report into the Pharmacy Technician Supervisor.

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 base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $19.11 - $25.08 per hour. The base pay for this role in all other locations is: $17.20 - $22.57 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Use Oscar and vendor tools to determine eligibility, screen for required documents, create, process, and properly track pharmacy prior authorization requests
• Prepare, organize, and distribute pharmacy prior authorization requests for review by pharmacist/physician and respond to pharmacist/physician requests for additional information
• Collect relevant medical information (via telephone, fax, and portal) and apply the appropriate PA criteria, clearly documenting all communication and decision making
• Meet required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review
• Communicate oral and written prior authorization outcome notifications that comply with standards and requirements for content and accuracy
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 2+ years of work experience in a pharmacy related field in a retail or managed care plan setting and/or prior authorization experience
• Active, unrestricted Pharmacy Technician certification (CPhT)
• Excellent customer service, phone etiquette, and typing skills

Bonus Points:

• 1+ years of performing pharmacy reviews for a managed care plan or pharmacy benefits manager
• Experience working with CVS Caremark's portal and criteria
• In-depth understanding of how to operationalize step therapy rules and regulations
• Strong verbal and written communications, and interpersonal interactions

Hi, we're Oscar. We're hiring a Prior Authorization Pharmacist to join our Pharmacy 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 serves as a reviewer of prior authorizations.

You will report into the Clinical Pharmacist Supervisor.

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 base pay for this role is: $ $111,780 -146,711.25 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs
• Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations
• Participate in clinical quality audits and inter-rater reliability testing
• Provide internal team support for escalations and questions
• Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 3+ years of experience as a licensed pharmacist
• 2+ years of experience performing prior authorization review in a managed care setting
• Active, unrestricted pharmacist license
• Doctor of Pharmacy Degree
• Willingness to obtain licensure/training with new states

Bonus points:

• Clinical experience applying clinical criteria in clinical review setting
• Board Certification (i.e. BCPS, BCOP)
• Residency training
• Experience practicing pharmacy in a clinical setting (i.e. retail, hospital, and specialty)

Hi, we're Oscar. We're hiring a Nurse Supervisor to join our Utilization Management Clinical Quality 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 provide day-to-day oversight and management of the team. You will also own daily Nurse team operations, including queue and volume throughput and staffing, and also serve as the primary escalation point for your teams. You will support strategic and clinical initiatives as needed.

You will report into the Manager, Clinical Programs

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. 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 is: $91,908 - $120,629 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Own daily workforce management, including staffing and queue assignments, PTO/leave, and payroll/compensation.
• Manage queue on a daily basis, ensuring compliance with regulatory timelines, staff coverage, and coordination with internal teams for forecasting and timely handling of ad hoc escalations
• Ensure team adheres to department policies and workflows and serve as continual champion of the Oscar mission.
• Drive and own the success of clinical auditing and performance through ongoing evaluations; effectively use Oscar tools to monitor and trend nurse productivity and auditing data for assessment and reporting.
• Support the onboarding and training of newly-hired clinicians and partner with the Clinical Quality & Training team on the development and maintenance of clinical training and resource material.
• Partner with the Talent Acquisition team on clinical hiring initiatives.
• Complete medical necessity and level of care reviews using clinical judgment and the Plan's designated clinical guidelines, if applicable.
• Comply with department performance and quality metrics, and adhere to training and remediation requirements.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Active, unrestricted Registered Nurse (RN) licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
• Associate Degree and/or Bachelors of Nursing from an accredited school of nursing
• 5+ years healthcare experience (including at least 2 years clinical practice in an acute care setting)
• 3+ years of utilization review experience at a managed care plan or provider organization
• 1+ years of direct-report leadership of a clinical team at a managed care plan or healthcare organization including in a virtual environment.
• A working knowledge of health insurance/benefit concepts - Medicare and Individual Marketplace insurance experience preferred.

Bonus points:

• Experience in healthcare quality assurance
• Strong understanding of NCQA accreditation standards for utilization management, case management or population health, HEDIS measures and other regulatory requirements
• CCM or MCG certification
• Experience analyzing and interpreting performance and other forms of data
• Proficiency using Google Suite

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 Utilization Review Nurse to join our Utilization Review 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 perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Texas, Georgia, Arizona, and Florida. 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 is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
• Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
• Meet required decision-making SLAs
• Refer members for further care engagement when needed
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
• Associate Degree or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing
• MCG or InterQual tooling experience
• Ability to obtain additional state licenses to meet business needs
• 1+ year of utilization review experience in a managed care setting
• 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)

Bonus points:

• BSN
• Previous experience conducting concurrent or inpatient reviews for a managed care plan

Hi, we're Oscar. We're hiring a Member Escalations Team Lead to join our 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

You will be the expert on production team workflows and is responsible for driving goals and KPIs for the team of support staff to meet business objectives while providing coaching and leadership. This role partners with stakeholders to assist members with their health insurance needs, while partnering with stakeholders to identify and develop workflow improvements to enhance efficiencies for the team.

You will report to the Manager, Member Escalations Operations.

Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. This is a remote role. You must reside in Georgia. #LI-Remote

Pay Transparency:

The base pay for this role in all other locations is: $55,890 - $73,355 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Hire and manage a team of Oscar colleagues with direct responsibility for performance management, their growth and development, and associated HR administrative tasks
• Manage your team's outcomes, monitor dashboards, and track operational KPIs, conducting root-cause analysis and constructing action plans when issues arise
• Understand and be connected to the type of work your team does on a daily basis, being able to make volume-based decisions that best serve our customers.
• Serve as a central communicator by leading team huddles with Oscar colleagues, connecting colleagues to the mission, vision, and values of Oscar, and providing guidance and motivation to achieve daily operational objectives
• Be a culture carrier, driving engagement with your team by creating an inclusive and inviting culture that aligns with Oscar's core values
• Actively lead and participate in continuous improvement activities that drive or influence the improvement and development of a high performing production team
• Identify and closing gaps on existing operational workflows
• Work collaboratively across production and other Oscar teams to implement best practice
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 2+ years experience in a customer service or escalations environment
• 1+ years healthcare and/or insurance experience
• 2+ years of direct people management experience
• 1+ years of experience using data and metrics to drive improvements
• 1+ years of experience working with teams in multiple locations and multiple disciplines
• 1+ years managing projects

Bonus Points

• Bachelor's degree
• 1+ years of claims processing experience
• Lean Six Sigma or Process Improvement certification
• Advanced Google Suite or Microsoft Office capabilities
• 2+ years experience solving complex inquiries

Hi, we're Oscar. We're hiring a Member Escalations Team Lead to join our 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

You will be the expert on production team workflows and is responsible for driving goals and KPIs for the team of support staff to meet business objectives while providing coaching and leadership. This role partners with stakeholders to assist members with their health insurance needs, while partnering with stakeholders to identify and develop workflow improvements to enhance efficiencies for the team.

You will report to the Manager, Member Escalations Operations.

Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. This is a remote role. You must reside in Florida. #LI-Remote

Pay Transparency:

The base pay for this role in all other locations is: $55,890 - $73,355 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Hire and manage a team of Oscar colleagues with direct responsibility for performance management, their growth and development, and associated HR administrative tasks
• Manage your team's outcomes, monitor dashboards, and track operational KPIs, conducting root-cause analysis and constructing action plans when issues arise
• Understand and be connected to the type of work your team does on a daily basis, being able to make volume-based decisions that best serve our customers.
• Serve as a central communicator by leading team huddles with Oscar colleagues, connecting colleagues to the mission, vision, and values of Oscar, and providing guidance and motivation to achieve daily operational objectives
• Be a culture carrier, driving engagement with your team by creating an inclusive and inviting culture that aligns with Oscar's core values
• Actively lead and participate in continuous improvement activities that drive or influence the improvement and development of a high performing production team
• Identify and closing gaps on existing operational workflows
• Work collaboratively across production and other Oscar teams to implement best practice
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 2+ years experience in a customer service or escalations environment
• 1+ years healthcare and/or insurance experience
• 2+ years of direct people management experience
• 1+ years of experience using data and metrics to drive improvements
• 1+ years of experience working with teams in multiple locations and multiple disciplines
• 1+ years managing projects

Bonus Points

• Bachelor's degree
• 1+ years of claims processing experience
• Lean Six Sigma or Process Improvement certification
• Advanced Google Suite or Microsoft Office capabilities
• 2+ years experience solving complex inquiries

Hi, we're Oscar. We're hiring a Member Escalations Team Lead to join our 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

You will be the expert on production team workflows and is responsible for driving goals and KPIs for the team of support staff to meet business objectives while providing coaching and leadership. This role partners with stakeholders to assist members with their health insurance needs, while partnering with stakeholders to identify and develop workflow improvements to enhance efficiencies for the team.

You will report to the Manager, Member Escalations Operations.

Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. This is a remote role. You must reside in Texas. #LI-Remote

Pay Transparency:

The base pay for this role in all other locations is: $55,890 - $73,355 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Hire and manage a team of Oscar colleagues with direct responsibility for performance management, their growth and development, and associated HR administrative tasks
• Manage your team's outcomes, monitor dashboards, and track operational KPIs, conducting root-cause analysis and constructing action plans when issues arise
• Understand and be connected to the type of work your team does on a daily basis, being able to make volume-based decisions that best serve our customers.
• Serve as a central communicator by leading team huddles with Oscar colleagues, connecting colleagues to the mission, vision, and values of Oscar, and providing guidance and motivation to achieve daily operational objectives
• Be a culture carrier, driving engagement with your team by creating an inclusive and inviting culture that aligns with Oscar's core values
• Actively lead and participate in continuous improvement activities that drive or influence the improvement and development of a high performing production team
• Identify and closing gaps on existing operational workflows
• Work collaboratively across production and other Oscar teams to implement best practice
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 2+ years experience in a customer service or escalations environment
• 1+ years healthcare and/or insurance experience
• 2+ years of direct people management experience
• 1+ years of experience using data and metrics to drive improvements
• 1+ years of experience working with teams in multiple locations and multiple disciplines
• 1+ years managing projects

Bonus Points

• Bachelor's degree
• 1+ years of claims processing experience
• Lean Six Sigma or Process Improvement certification
• Advanced Google Suite or Microsoft Office capabilities
• 2+ years experience solving complex inquiries

Hi, we're Oscar. We're hiring a Member Escalations Team Lead to join our 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

You will be the expert on production team workflows and is responsible for driving goals and KPIs for the team of support staff to meet business objectives while providing coaching and leadership. This role partners with stakeholders to assist members with their health insurance needs, while partnering with stakeholders to identify and develop workflow improvements to enhance efficiencies for the team.

You will report to the Manager, Member Escalations Operations.

Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. This is a remote role. You must reside in Arizona. #LI-Remote

Pay Transparency:

The base pay for this role in all other locations is: $55,890 - $73,355 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Hire and manage a team of Oscar colleagues with direct responsibility for performance management, their growth and development, and associated HR administrative tasks
• Manage your team's outcomes, monitor dashboards, and track operational KPIs, conducting root-cause analysis and constructing action plans when issues arise
• Understand and be connected to the type of work your team does on a daily basis, being able to make volume-based decisions that best serve our customers.
• Serve as a central communicator by leading team huddles with Oscar colleagues, connecting colleagues to the mission, vision, and values of Oscar, and providing guidance and motivation to achieve daily operational objectives
• Be a culture carrier, driving engagement with your team by creating an inclusive and inviting culture that aligns with Oscar's core values
• Actively lead and participate in continuous improvement activities that drive or influence the improvement and development of a high performing production team
• Identify and closing gaps on existing operational workflows
• Work collaboratively across production and other Oscar teams to implement best practice
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 2+ years experience in a customer service or escalations environment
• 1+ years healthcare and/or insurance experience
• 2+ years of direct people management experience
• 1+ years of experience using data and metrics to drive improvements
• 1+ years of experience working with teams in multiple locations and multiple disciplines
• 1+ years managing projects

Bonus Points

• Bachelor's degree
• 1+ years of claims processing experience
• Lean Six Sigma or Process Improvement certification
• Advanced Google Suite or Microsoft Office capabilities
• 2+ years experience solving complex inquiries

Hi, we're Oscar. We're hiring a Bilingual Customer Service Representative to join our Member and Provider Services 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 a volume-driven customer service and production-based role that handles the daily activities involved in running a health insurance company including customer interactions and back office tasks following standard operating procedures.

You will report to the Concierge Operations Manager.

Work Location: This is a remote position, open to candidates who reside in: Texas. 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: he set pay rate for this role is $19.00 per hour. You may be eligible to receive an additional $1.00 per hour upon successful completion of the bilingual assessment. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Work Schedule: We offer a variety of full-time shift options. All available schedules are Monday through Friday.

Available Texas (CST) Shifts:

• 7:00 AM – 3:30 PM
• 8:00 AM – 4:30 PM
• 8:00 AM – 5:00 PM
• 1:00 AM – 7:30 PM

Responsibilities:

• Develop a comprehensive understanding of the current processes, procedures, and tools associated with the Oscar business model.
• Work with members, brokers, providers, and Oscar vendors through multiple channels according to assignment needs
• Manage an assigned caseload, maintaining service delivery, productivity, and quality expectations
• Form working relationships with all partners.
• Support the leadership team by identifying issues through established escalation pathways
• Monitor and track the health of all assigned work-in-progress issues.
• Escalate and resolve issues to ensure appropriate turnaround times
• Participate in process improvement projects
• Comply with all operational, regulatory, and compliance standards relating to member Personal Health Information (PHI)
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Must be bilingual in Spanish and English with full professional proficiency in reading, writing, and speaking.
• 1+ years of experience in a high-volume or customer-focused setting.
• 6+ months of healthcare experience
• High school diploma or GED

Bonus points:

• Strong quantitative or analytical skills focused on identifying or solving problems
• Experience manipulating and entering accurate data
• Advanced Google Suite or Microsoft Office capabilities

Hi, we're Oscar. We're hiring a Bilingual Customer Service Representative to join our Member and Provider Services 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 a volume-driven customer service and production-based role that handles the daily activities involved in running a health insurance company including customer interactions and back office tasks following standard operating procedures.

You will report to the Concierge Operations Manager.

Work Location: This is a remote position, open to candidates who reside in: Georgia. 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: he set pay rate for this role is $19.00 per hour. You may be eligible to receive an additional $1.00 per hour upon successful completion of the bilingual assessment. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Work Schedule: We offer a variety of full-time shift options. All available schedules are Monday through Friday.

Available Georgia (EST) Shifts:

• 8:00 AM – 4:30 PM
• 9:00 AM – 5:30 PM
• 9:00 AM – 6:00 PM
• 12:00 PM – 8:30 PM

Responsibilities:

• Develop a comprehensive understanding of the current processes, procedures, and tools associated with the Oscar business model.
• Work with members, brokers, providers, and Oscar vendors through multiple channels according to assignment needs
• Manage an assigned caseload, maintaining service delivery, productivity, and quality expectations
• Form working relationships with all partners.
• Support the leadership team by identifying issues through established escalation pathways
• Monitor and track the health of all assigned work-in-progress issues.
• Escalate and resolve issues to ensure appropriate turnaround times
• Participate in process improvement projects
• Comply with all operational, regulatory, and compliance standards relating to member Personal Health Information (PHI)
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Must be bilingual in Spanish and English with full professional proficiency in reading, writing, and speaking.
• 1+ years of experience in a high-volume or customer-focused setting.
• 6+ months of healthcare experience
• High school diploma or GED

Bonus points:

• Strong quantitative or analytical skills focused on identifying or solving problems
• Experience manipulating and entering accurate data
• Advanced Google Suite or Microsoft Office capabilities

Hi, we're Oscar. We're hiring a Bilingual Customer Service Representative to join our Member and Provider Services 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 a volume-driven customer service and production-based role that handles the daily activities involved in running a health insurance company including customer interactions and back office tasks following standard operating procedures.

You will report to the Concierge Operations Manager.

Work Location: This is a remote position, open to candidates who reside in: Florida. 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: he set pay rate for this role is $19.00 per hour. You may be eligible to receive an additional $1.00 per hour upon successful completion of the bilingual assessment. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Work Schedule: We offer a variety of full-time shift options. All available schedules are Monday through Friday.

Available Florida (EST) Shifts:

• 8:00 AM – 4:30 PM
• 9:00 AM – 5:30 PM
• 9:00 AM – 6:00 PM
• 12:00 PM – 8:30 PM

Responsibilities:

• Develop a comprehensive understanding of the current processes, procedures, and tools associated with the Oscar business model.
• Work with members, brokers, providers, and Oscar vendors through multiple channels according to assignment needs
• Manage an assigned caseload, maintaining service delivery, productivity, and quality expectations
• Form working relationships with all partners.
• Support the leadership team by identifying issues through established escalation pathways
• Monitor and track the health of all assigned work-in-progress issues.
• Escalate and resolve issues to ensure appropriate turnaround times
• Participate in process improvement projects
• Comply with all operational, regulatory, and compliance standards relating to member Personal Health Information (PHI)
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Must be bilingual in Spanish and English with full professional proficiency in reading, writing, and speaking.
• 1+ years of experience in a high-volume or customer-focused setting.
• 6+ months of healthcare experience
• High school diploma or GED

Bonus points:

• Strong quantitative or analytical skills focused on identifying or solving problems
• Experience manipulating and entering accurate data
• Advanced Google Suite or Microsoft Office capabilities

Hi, we're Oscar. We're hiring a Bilingual Customer Service Representative to join our Member and Provider Services 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 a volume-driven customer service and production-based role that handles the daily activities involved in running a health insurance company including customer interactions and back office tasks following standard operating procedures.

You will report to the Concierge Operations Manager.

Work Location: This is a remote position, open to candidates who reside in: Arizona. 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: he set pay rate for this role is $19.00 per hour. You may be eligible to receive an additional $1.00 per hour upon successful completion of the bilingual assessment. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Work Schedule & Availability We offer a variety of full-time shift options. All available schedules are Monday through Friday.

Available Arizona (MST) Shifts:

• 5:00 AM – 1:30 PM
• 6:00 AM – 2:30 PM
• 6:00 AM – 3:00 PM
• 9:00 AM – 5:30 PM

Responsibilities:

• Develop a comprehensive understanding of the current processes, procedures, and tools associated with the Oscar business model.
• Work with members, brokers, providers, and Oscar vendors through multiple channels according to assignment needs
• Manage an assigned caseload, maintaining service delivery, productivity, and quality expectations
• Form working relationships with all partners.
• Support the leadership team by identifying issues through established escalation pathways
• Monitor and track the health of all assigned work-in-progress issues.
• Escalate and resolve issues to ensure appropriate turnaround times
• Participate in process improvement projects
• Comply with all operational, regulatory, and compliance standards relating to member Personal Health Information (PHI)
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Must be bilingual in Spanish and English with full professional proficiency in reading, writing, and speaking.
• 1+ years of experience in a high-volume or customer-focused setting.
• 6+ months of healthcare experience
• High school diploma or GED

Bonus points:

• Strong quantitative or analytical skills focused on identifying or solving problems
• Experience manipulating and entering accurate data
• Advanced Google Suite or Microsoft Office capabilities

Hi, we're Oscar. We're hiring a Full-Time Customer Service Representative to join our Member and Provider Services 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 a volume-driven customer service and production-based role that handles the daily activities involved in running a health insurance company including customer interactions and back office tasks following standard operating procedures.

You will report into the Concierge Operations Manager.

Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. This is a remote role. You must reside in Texas. #LI-Remote

Pay Transparency: he set pay rate for this role is $19.00 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Available Texas (CST) Shifts:

• 7:00 AM – 3:30 PM
• 8:00 AM – 4:30 PM
• 8:00 AM – 5:00 PM
• 1:00 AM – 7:30 PM
• 2:00 PM – 11:00 PM

Responsibilities:

• Develop a comprehensive understanding of the current processes, procedures, and tools associated with the Oscar business model.
• Work with members, brokers, providers, and Oscar vendors through multiple channels according to assignment needs
• Manage an assigned caseload, maintaining service delivery, productivity, and quality expectations
• Form working relationships with all partners.
• Support the leadership team by identifying issues through established escalation pathways
• Monitor and track the health of all assigned work-in-progress issues.
• Escalate and resolve issues to ensure appropriate turnaround times
• Participate in process improvement projects
• Comply with all operational, regulatory, and compliance standards relating to member Personal Health Information (PHI)
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 1+ years of experience in a high-volume or customer-focused setting.
• 6+ Months of healthcare experience
• High school diploma or GED

Bonus points:

• Strong quantitative or analytical skills focused on identifying or solving problems
• Must be bilingual in Spanish and English with full professional proficiency in reading, writing, and speaking.
• Experience manipulating and entering accurate data
• Advanced Google Suite or Microsoft Office capabilities

Hi, we're Oscar. We're hiring a Full-Time Customer Service Representative to join our Member and Provider Services 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 a volume-driven customer service and production-based role that handles the daily activities involved in running a health insurance company including customer interactions and back office tasks following standard operating procedures.

You will report into the Concierge Operations Manager.

Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. This is a remote role. You must reside in Georgia. #LI-Remote

Pay Transparency: he set pay rate for this role is $19.00 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Work Schedule: We offer a variety of full-time shift options. All available schedules are Monday through Friday.

Available Georgia (EST) Shifts:

• 8:00 AM – 4:30 PM
• 9:00 AM – 5:30 PM
• 9:00 AM – 6:00 PM
• 12:00 PM – 8:30 PM
• 3:00 PM – 12:00 AM

Responsibilities:

• Develop a comprehensive understanding of the current processes, procedures, and tools associated with the Oscar business model.
• Work with members, brokers, providers, and Oscar vendors through multiple channels according to assignment needs
• Manage an assigned caseload, maintaining service delivery, productivity, and quality expectations
• Form working relationships with all partners.
• Support the leadership team by identifying issues through established escalation pathways
• Monitor and track the health of all assigned work-in-progress issues.
• Escalate and resolve issues to ensure appropriate turnaround times
• Participate in process improvement projects
• Comply with all operational, regulatory, and compliance standards relating to member Personal Health Information (PHI)
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 1+ years of experience in a high-volume or customer-focused setting.
• 6+ Months of healthcare experience
• High school diploma or GED

Bonus points:

• Strong quantitative or analytical skills focused on identifying or solving problems
• Must be bilingual in Spanish and English with full professional proficiency in reading, writing, and speaking.
• Experience manipulating and entering accurate data
• Advanced Google Suite or Microsoft Office capabilities

Hi, we're Oscar. We're hiring a Full-Time Customer Service Representative to join our Member and Provider Services 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 a volume-driven customer service and production-based role that handles the daily activities involved in running a health insurance company including customer interactions and back office tasks following standard operating procedures.

You will report into the Concierge Operations Manager.

Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. This is a remote role. You must reside in Florida. #LI-Remote

Pay Transparency: he set pay rate for this role is $19.00 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Work Schedule: We offer a variety of full-time shift options. All available schedules are Monday through Friday.

Available Florida (EST) Shifts:

• 8:00 AM – 4:30 PM
• 9:00 AM – 5:30 PM
• 9:00 AM – 6:00 PM
• 12:00 PM – 8:30 PM
• 3:00 PM – 12:00 AM

Responsibilities:

• Develop a comprehensive understanding of the current processes, procedures, and tools associated with the Oscar business model.
• Work with members, brokers, providers, and Oscar vendors through multiple channels according to assignment needs
• Manage an assigned caseload, maintaining service delivery, productivity, and quality expectations
• Form working relationships with all partners.
• Support the leadership team by identifying issues through established escalation pathways
• Monitor and track the health of all assigned work-in-progress issues.
• Escalate and resolve issues to ensure appropriate turnaround times
• Participate in process improvement projects
• Comply with all operational, regulatory, and compliance standards relating to member Personal Health Information (PHI)
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 1+ years of experience in a high-volume or customer-focused setting.
• 6+ Months of healthcare experience
• High school diploma or GED

Bonus points:

• Strong quantitative or analytical skills focused on identifying or solving problems
• Must be bilingual in Spanish and English with full professional proficiency in reading, writing, and speaking.
• Experience manipulating and entering accurate data
• Advanced Google Suite or Microsoft Office capabilities

Hi, we're Oscar. We're hiring a Full-Time Customer Service Representative to join our Member and Provider Services 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 a volume-driven customer service and production-based role that handles the daily activities involved in running a health insurance company including customer interactions and back office tasks following standard operating procedures.

You will report into the Concierge Operations Manager.

Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. This is a remote role. You must reside in Arizona. #LI-Remote

Pay Transparency: he set pay rate for this role is $19.00 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Work Schedule: We offer a variety of full-time shift options. All available schedules are Monday through Friday.

Available Arizona (MST) Shifts:

• 5:00 AM – 1:30 PM
• 6:00 AM – 2:30 PM
• 6:00 AM – 3:00 PM
• 9:00 AM – 5:30 PM
• 12:00 PM – 9:00 PM

Responsibilities:

• Develop a comprehensive understanding of the current processes, procedures, and tools associated with the Oscar business model.
• Work with members, brokers, providers, and Oscar vendors through multiple channels according to assignment needs
• Manage an assigned caseload, maintaining service delivery, productivity, and quality expectations
• Form working relationships with all partners.
• Support the leadership team by identifying issues through established escalation pathways
• Monitor and track the health of all assigned work-in-progress issues.
• Escalate and resolve issues to ensure appropriate turnaround times
• Participate in process improvement projects
• Comply with all operational, regulatory, and compliance standards relating to member Personal Health Information (PHI)
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 1+ years of experience in a high-volume or customer-focused setting.
• 6+ Months of healthcare experience
• High school diploma or GED

Bonus points:

• Strong quantitative or analytical skills focused on identifying or solving problems
• Must be bilingual in Spanish and English with full professional proficiency in reading, writing, and speaking.
• Experience manipulating and entering accurate data
• Advanced Google Suite or Microsoft Office capabilities

Hi, we're Oscar. We're hiring a Care Navigation Nurse to join our Care Navigation 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 requires extensive clinical knowledge and initiative to perform in-depth research, problem-solving, and decision-making to source and route to medically appropriate care, verify network gaps, escalate issues to appropriate stakeholders, guide the Care Navigation team in searches, and improve member experience. Additionally, you will provide ongoing clinical education to non-clinical teams to provide a strong foundation to be utilized in their workings with members.

You will report into the Clinical Care Navigation Lead.

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 base pay for this role is: $39.28 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Help coordinate care across a variety of settings (inpatient, outpatient, post acute, ER, home care)
• Actively reach out to members undergoing difficult health challenges and develop care plans
• Proactively reach out to hospital case managers to assist with discharge planning
• Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license
• Ability to obtain additional state licenses to meet business needs
• 3+ years of clinical experience to include hospital, outpatient or community based care management
• 3+ years of experience in Care Coordination and Navigation

Bonus points:

• BSN
• Working knowledge of Milliman Guidelines
• CCM Certification
• Behavioral Health experience

Hi, we're Oscar. We're hiring a Complex Case Management Nurse to join our CCM 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 educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with support teams to ensure exceptional care for our members.

You will report into the Associate Director, Clinical.

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 base pay for this role is: $39.28 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care)
• Actively reach out to members undergoing difficult health challenges and develop care plans
• Proactively reach out to hospital case managers to assist with discharge planning
• Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures
• Ensure compliance with all CCM NCQA standards in day to day practice and workflows.
• Compliance with all applicable laws and regulations
• Other duties as assigned
• Requirements:

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license
• Ability to obtain additional state licenses to meet business needs
• 2+ years of clinical experience to include payer, hospital, outpatient or community based care management
• 1+ years of experience in Care Coordination and Navigation

Bonus points:

• CCM Certification
• NCQA knowledge and accreditation experience
• Bilingual in spanish and or creole reading, writing, speaking
• BSN
• Working knowledge of Milliman Guidelines

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, Network Contracting to join our Specialist Contracting 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 managing contracts with key healthcare providers in Oscar's network (hospital/health systems and large national ancillary groups) to build and maintain a robust network; while also ensuring access to quality care and optimizing costs by analyzing provider performance and negotiating reimbursement rates, often involving complex contract terms and compliance with regulatory guidelines. Supporting cost saving initiatives, executing national network strategy, and ensuring high performing network development and ensuring providers across our service area have the information and support they need to provide best-in-class member care.

You will report into the Senior Director, Speciality Contracting.

Work Location: This is a remote position based in the field, open to candidates who reside: Arizona, California, Florida, Illinois, Iowa, Kansas, Michigan, Mississippi, Missouri, New York, Nebraska, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, or Virginia. Your daily work will involve a blend of work from your home office and frequent travel for client meetings. #LI-Remote

Pay Transparency: The base pay for this role in New York and California is: $96,876 - $127,149 per year. The base pay for all other locations is: $87,560 - $114,434 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Travel requirement up to 20%

Responsibilities:

• Implement contracting strategies under the direction of Network Director and/or Senior Manager and in partnership with Market Leaders that align with the company's overall network adequacy, development and cost management objectives.
• Manage and negotiate contracts with assigned healthcare providers, focusing on favorable terms and compliance with organizational standards and regulatory requirements.
• Support comprehensive reviews and analyses of assigned provider contracts, identifying areas for improvement and optimization.
• Utilize data and analytics of provider financial issues and competitor strategies to support informing negotiation and contracting decisions.
• Meet defined metrics and SLAs including but not limited to provider outreach and contract completion.
• Collaborate with the provider services team regarding the servicing, education and communication to our provider network.
• Monitor assigned networks to gauge compliance with standards, developing corrective action plans with network contracting and market leadership to remediate deficiencies.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 3+ years of experience in healthcare client management, healthcare consulting, or provider healthcare contracting, healthcare operations, or a related field
• 2+ years of experience supporting provider network strategy development and negotiating provider contracts
• 1+ years experience running financial analyses on a markets or product lines, and working cross-functionally to support driving improvement opportunities
• 1+ years experience navigating and organizing large data sets such as claim files and provider rosters

Bonus points:

• Associate's degree or equivalent professional working experience.