Associate Director, Claims Documentation

Hi, we're Oscar. We're hiring an Associate Director, Claims Documentation to join our Claims team.

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

About the role

The Associate Director, Documentation is responsible for documenting, analyzing, and improving claims processing workflows, policies, and procedures. You will utilize strong writing skills, healthcare claims knowledge, and the ability to collaborate with multiple stakeholders across Oscar. 

You will report to the Senior Director, Claims.

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. 

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.  

You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $144,000 - $189,000 per year. The base pay for this role in all other locations is: $129,600 - $170,100 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

• Develop and maintain detailed process documentation, including standard operating procedures (SOPs), work instructions, and guidelines related to healthcare claims processing specifically.
• Ensure accuracy, clarity, and compliance with industry standards and regulatory requirements.
• Analyze current claims processing workflows to identify inefficiencies and areas for improvement.
• Work closely with internal claims department  stakeholders and  audit teams and tech partners  to understand existing processes and recommend best practices.
• Stay updated on healthcare regulations, including HIPAA, CMS guidelines, and insurance policies, to ensure compliance in documentation and processes.
• Work with cross-functional teams, including Tech, quality assurance, and compliance teams, to gather information and improve process efficiency.
• Translate technical or complex information into clear, user-friendly documentation.
• Assist in developing training materials, FAQs, and user manuals for new hires and existing staff.
• Manage open provider claim dispute inventory and mitigation of interest bearing claims payment
• Responsible for ongoing career development of the team by  maintaining culture, employee satisfaction and team performance management.
• Develop annual and ad-hoc training program for team members and managers
• Compliance with all applicable laws and regulations 
• Other duties as assigned

Qualifications

• 7+ years of experience in claims operations including, communication or other Technical writing 
• 5+ years of experience in people management and team leadership experience with ability to prioritize, allocate work and manage across multiple high-value projects at once
• 3+ years of experience with benefit and contract interpretation or coding in professional/ institutional billing requirements. 
• 3+ years of experience managing claims across multiple product types (i.e. Medicare or Commercial). 
• 3+ years of experience analyzing and improving processes and workflows.
• 5+ years of experience working with technical teams (e.g. engineering and product) in translating business requirement specifications

Bonus Points

• Bachelor's degree in communications, or 4 years commensurate experience.
• Experience in making data-driven decisions in a fast paced environment
• Excellent leadership and communication skills to drive decision-making and results across multiple partners.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency:  Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.