Specialist, Claims Quality Regulatory Operations

Hi, we're Oscar. We're hiring a Specialist, Claims Quality Regulatory Operations to join our Claims Quality 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 Specialist, Claims Regulatory Operations will support compliance within Provider Operations by coordinating responses, and delivering positive outcomes based on inputs from stakeholders. You will help advance compliance efforts by conducting detailed data analysis, supporting the preparation of Market Conduct Exam exhibits/narratives and the policies & procedures review process within Operations.

You will report to the Sr. Manager, Payment Quality.

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, 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: $69,600 - $91,350 per year. The base pay for this role in all other locations is: $62,640 - $82,215 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

• Collaborate with team members and leaders to address process gaps and improvements.
• Review data pulls and conduct detailed analysis to support compliance initiatives.
• Develop trusting relationships with internal and external stakeholders through effective communication and collaboration. 
• Draft detailed narratives and reports to communicate compliance findings and updates, including responses to Regulator/NCQA requests and examinations.
• Support …