Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management 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 determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.

Hours: 8am - 5pm in your local time zone

Call rotation - 1 weekend every 16 weeks

You will report into the Associate Medical Director, Utilization Management.

Work Location: This is a remote position, open to candidates who reside in the United States. 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: $211,200 - $ 277,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation, and annual performance bonuses.

Responsibilities:

• Provide timely medical reviews that meet Oscar's stringent quality parameters.
• Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen.
• Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level).
• Use correct templates for documenting decisions during case review.
• Meet the appropriate turn-around times for clinical reviews.
• Receive and review escalated reviews.
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Board certification as an MD or DO
• Licensed in one of these states: FL, NC, AZ OR possess an active Interstate Medical Licensure Compact (IMLC).
• 6+ years of clinical practice

Bonus points:

• Licensure in multiple Oscar states
• 1+ years of utilization review experience in a managed care plan (health care industry)
• BC in Cardiology, Radiation/Oncology, or Neurology
• Experience with care management within the health insurance industry.
• Willing and able to obtain additional state licensure as needed, with Oscar's support

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

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Senior Analyst, Actuarial will play a key role in Oscar’s valuation function, focusing specifically on risk adjustment across all Affordable Care Act (ACA) markets. This role will own the maintenance and review of actuarial models used to develop risk adjustment accrual estimates, forecasting estimates, and various other analyses.  This is a very dynamic space, which makes this a great opportunity to work on interesting projects and have a BIG impact.

You will report into the Director, Actuarial.

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: $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:

• Model Management: Maintain and enhance core risk adjustment reporting and forecasting models, ensuring consistency and standardization across all team users.
• Infrastructure & Design: Serve as a key contributor in improving modeling infrastructure; develop recommendations for model design decisions, best practices, and automation/documentation standards.
• Financial Strategy: Develop recommendations for the risk adjustment accrual setting process and provide data-driven insights for the financial planning process.
• Trend Analysis: Identify, triage, and investigate core drivers of observed trends across plan designs, providers, vendors, and markets.
• Stakeholder Engagement: Maintain strong relationships and clear lines of communication with internal and external stakeholders.
• Team Development: Aid in the onboarding of new analysts by collaborating and integrating them into existing processes.
• Governance: Compliance with all applicable laws and regulations.
• Other duties as assigned.
•  

Requirements:

• Bachelor's degree in a STEM field.
• Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one.
• 3+ years of experience in a related field.

Bonus points:

• Strong knowledge of core health insurance concepts and experience with actuarial applications.
• Highly technical with a strong enthusiasm to apply tech-forward methods in actuarial models.

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

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Senior Analyst, Actuarial will play a key role in Oscar’s valuation function, focusing specifically on risk adjustment across all Affordable Care Act (ACA) markets. This role will own the maintenance and review of actuarial models used to develop risk adjustment accrual estimates, forecasting estimates, and various other analyses.  This is a very dynamic space, which makes this a great opportunity to work on interesting projects and have a BIG impact.

You will report into the Director, Actuarial.

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 - $133,670.25 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Model Management: Maintain and enhance core risk adjustment reporting and forecasting models, ensuring consistency and standardization across all team users.
• Infrastructure & Design: Serve as a key contributor in improving modeling infrastructure; develop recommendations for model design decisions, best practices, and automation/documentation standards.
• Financial Strategy: Develop recommendations for the risk adjustment accrual setting process and provide data-driven insights for the financial planning process.
• Trend Analysis: Identify, triage, and investigate core drivers of observed trends across plan designs, providers, vendors, and markets.
• Stakeholder Engagement: Maintain strong relationships and clear lines of communication with internal and external stakeholders.
• Team Development: Aid in the onboarding of new analysts by collaborating and integrating them into existing processes.
• Governance: Compliance with all applicable laws and regulations.
• Other duties as assigned.
•  

Requirements:

• Bachelor's degree in a STEM field.
• Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one.
• 3+ years of experience in a related field.

Bonus points:

• Strong knowledge of core health insurance concepts and experience with actuarial applications.
• Highly technical with a strong enthusiasm to apply tech-forward methods in actuarial models.

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

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Senior Analyst, Actuarial will play a key role in Oscar’s valuation function, focusing specifically on risk adjustment across all Affordable Care Act (ACA) markets. This role will own the maintenance and review of actuarial models used to develop risk adjustment accrual estimates, forecasting estimates, and various other analyses.  This is a very dynamic space, which makes this a great opportunity to work on interesting projects and have a BIG impact.

You will report into the Director, Actuarial.

Work Location: This is a remote position, open to candidates who reside in:  Hartford, CT. 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: $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:

• Model Management: Maintain and enhance core risk adjustment reporting and forecasting models, ensuring consistency and standardization across all team users.
• Infrastructure & Design: Serve as a key contributor in improving modeling infrastructure; develop recommendations for model design decisions, best practices, and automation/documentation standards.
• Financial Strategy: Develop recommendations for the risk adjustment accrual setting process and provide data-driven insights for the financial planning process.
• Trend Analysis: Identify, triage, and investigate core drivers of observed trends across plan designs, providers, vendors, and markets.
• Stakeholder Engagement: Maintain strong relationships and clear lines of communication with internal and external stakeholders.
• Team Development: Aid in the onboarding of new analysts by collaborating and integrating them into existing processes.
• Governance: Compliance with all applicable laws and regulations.
• Other duties as assigned.
•  

Requirements:

• Bachelor's degree in a STEM field.
• Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one.
• 3+ years of experience in a related field.

Bonus points:

• Strong knowledge of core health insurance concepts and experience with actuarial applications.
• Highly technical with a strong enthusiasm to apply tech-forward methods in actuarial models.

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

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Senior Analyst, Actuarial will play a key role in Oscar’s valuation function, focusing specifically on risk adjustment across all Affordable Care Act (ACA) markets. This role will own the maintenance and review of actuarial models used to develop risk adjustment accrual estimates, forecasting estimates, and various other analyses.  This is a very dynamic space, which makes this a great opportunity to work on interesting projects and have a BIG impact.

You will report into the Director, Actuarial.

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

• Model Management: Maintain and enhance core risk adjustment reporting and forecasting models, ensuring consistency and standardization across all team users.
• Infrastructure & Design: Serve as a key contributor in improving modeling infrastructure; develop recommendations for model design decisions, best practices, and automation/documentation standards.
• Financial Strategy: Develop recommendations for the risk adjustment accrual setting process and provide data-driven insights for the financial planning process.
• Trend Analysis: Identify, triage, and investigate core drivers of observed trends across plan designs, providers, vendors, and markets.
• Stakeholder Engagement: Maintain strong relationships and clear lines of communication with internal and external stakeholders.
• Team Development: Aid in the onboarding of new analysts by collaborating and integrating them into existing processes.
• Governance: Compliance with all applicable laws and regulations.
• Other duties as assigned.
•  

Requirements:

• Bachelor's degree in a STEM field.
• Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one.
• 3+ years of experience in a related field.

Bonus points:

• Strong knowledge of core health insurance concepts and experience with actuarial applications.
• Highly technical with a strong enthusiasm to apply tech-forward methods in actuarial models.

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

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Senior Analyst, Actuarial will play a key role in Oscar’s valuation function, focusing specifically on risk adjustment across all Affordable Care Act (ACA) markets. This role will own the maintenance and review of actuarial models used to develop risk adjustment accrual estimates, forecasting estimates, and various other analyses.  This is a very dynamic space, which makes this a great opportunity to work on interesting projects and have a BIG impact.

You will report into the Director, Actuarial.

Work Location: This is a remote position, open to candidates who reside in:  Dallas, TX. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $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:

• Model Management: Maintain and enhance core risk adjustment reporting and forecasting models, ensuring consistency and standardization across all team users.
• Infrastructure & Design: Serve as a key contributor in improving modeling infrastructure; develop recommendations for model design decisions, best practices, and automation/documentation standards.
• Financial Strategy: Develop recommendations for the risk adjustment accrual setting process and provide data-driven insights for the financial planning process.
• Trend Analysis: Identify, triage, and investigate core drivers of observed trends across plan designs, providers, vendors, and markets.
• Stakeholder Engagement: Maintain strong relationships and clear lines of communication with internal and external stakeholders.
• Team Development: Aid in the onboarding of new analysts by collaborating and integrating them into existing processes.
• Governance: Compliance with all applicable laws and regulations.
• Other duties as assigned.
•  

Requirements:

• Bachelor's degree in a STEM field.
• Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one.
• 3+ years of experience in a related field.

Bonus points:

• Strong knowledge of core health insurance concepts and experience with actuarial applications.
• Highly technical with a strong enthusiasm to apply tech-forward methods in actuarial models.

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

Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

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

You will report to the Manager, SIU Coding Audit.

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

Responsibilities

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

Qualifications

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

Bonus Points

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

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

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Senior Analyst, Actuarial will play a key role in Oscar’s valuation function, focusing specifically on risk adjustment across all Affordable Care Act (ACA) markets. This role will own the maintenance and review of actuarial models used to develop risk adjustment accrual estimates, forecasting estimates, and various other analyses.  This is a very dynamic space, which makes this a great opportunity to work on interesting projects and have a BIG impact.

You will report into the Director, Actuarial.

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

Pay Transparency: The base pay for this role is: $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:

• Model Management: Maintain and enhance core risk adjustment reporting and forecasting models, ensuring consistency and standardization across all team users.
• Infrastructure & Design: Serve as a key contributor in improving modeling infrastructure; develop recommendations for model design decisions, best practices, and automation/documentation standards.
• Financial Strategy: Develop recommendations for the risk adjustment accrual setting process and provide data-driven insights for the financial planning process.
• Trend Analysis: Identify, triage, and investigate core drivers of observed trends across plan designs, providers, vendors, and markets.
• Stakeholder Engagement: Maintain strong relationships and clear lines of communication with internal and external stakeholders.
• Team Development: Aid in the onboarding of new analysts by collaborating and integrating them into existing processes.
• Governance: Compliance with all applicable laws and regulations.
• Other duties as assigned.
•  

Requirements:

• Bachelor's degree in a STEM field.
• Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one.
• 3+ years of experience in a related field.

Bonus points:

• Strong knowledge of core health insurance concepts and experience with actuarial applications.
• Highly technical with a strong enthusiasm to apply tech-forward methods in actuarial models.