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 creation of Policies & Procedures within Operations, ensuring that all policies and procedures are up-to-date and meet internal requirements as outlined by Compliance team.
• Assist in preparing for Market Conduct Exams and other regulatory reviews.
• Stay informed on business requirements and act on regulatory updates guided by Oscar’s Compliance team to ensure adherence to effective processes and procedures 
• Other duties as assigned 
• Compliance with all applicable laws and regulations

Qualifications

• Demonstrated understanding of Provider operations in the health payer industry.
• 1+ years of relevant experience working with operational compliance, regulatory, and data analysis within Healthcare Claims.
• 1+ years experience designing and improving workflows

Bonus Points

• 1+ years experience working with regulatory bodies and Market Conduct Exams
• Regulatory experience
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training 
• 1+ years experience using data software (e.g. Excel, VGA, Macros, SQL and/or Python) to manipulate and analyze large data sets to solve business problems

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.

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.