Utilization Review Processor

Hi, we're Oscar. We're hiring a Utilization Review Processor to join our Utilization Review 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 solve complex issues or concerns impacting our providers and the members they serve. You will communicate with our Providers and work with teams across Oscar to provide efficient and thorough resolution by providing world class service. You will understand the importance of a world-class member experience when seeking care and actively identifies barriers to member care and member and provider satisfaction to solve for the future. You will manage their workload effectively by setting timely outreaches and actively communicating roadblocks to their team.

You will report to the Utilization Review Lead.

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 is: $19.00 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 10 days per year.

Responsibilities

• Manage queue work and and assigned caseload through efficient dashboard management
• Identify, investigate, and resolve issues within determined SLAs
• Collaborate with colleagues, Specialists, Experts, and Leads to identify trends and roadblocks
• Use internal tools and resources seamlessly
• Communicate findings and resolutions with providers and internal departments
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 1+ years of customer support/service experience

Bonus Points

• Advanced computer literacy skills with experience using CRM and knowledge management tools to resolve client issues
• Experience using ticket management and reporting tools
• Experience managing an assignment caseload
• Customer service experience
• Healthcare and/or SAAS experience

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.