VP, Claims System Configuration

Hi, we're Oscar. We're hiring a Vice President, Configuration team to join our Operations 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 Vice President, Configuration is responsible for defining and driving the Claims and benefits configuration strategy and performance by partnering closely with senior leaders in Operations, Technology, and other departments across the organization.  Configuration responsibilities include defining, delivering, and measuring efficient and effective claims model that ensures we are paying claims accurately, positively impacting the member and provider experience.  Leveraging internal infrastructure, this role leads a cross functional technical implementation team in alignment with Oscars corporate strategy, key performance metrics, and industry regulations.

You will report to the SVP, Infrastructure Operations.

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: $232,000 - $305,500 per year.  You are also eligible for employee benefits,(participation in Oscar’s unlimited vacation program, (company equity grants and annual performance bonuses.

Responsibilities

• Define the claims design vision in partnership w/ key cross functional stakeholders and executives
• Lead the organization that supports and builds scalable processes for benefit configuration, claims adjudication, and provider payments identifying by the most important and impactful processes and systematically map them to apply technology to automate and improve them while ensuring compliance, quality and cost effectiveness
• Provide business requirements and cross functional support in the building, configuring, and improving Oscar’s technology platform(s) for adjudicating claims accurately and efficiently
• Manage, develop and maintain relationships cross-functionally to drive multi department collaboration to drive results for strategic initiatives
• Lead, coach and develop a high-performing team of managers and their reports - create a culture of compliance and end user satisfaction
• Set up monitoring and metrics to consistently and accurately track outcomes
• Manage team departmental budget 
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 15+ years experience in claims and benefit management, and/or data analysis or consulting in the healthcare space
• 5+ years of experience in health plan administration configuration with an emphasis on designing and reengineering healthcare operational processes
• 10+ years of experience building, coaching and developing technical or operational teams
• 10+ years experience in analytics & ability to derive insights from complex, broad datasets

Bonus Points

• An academic and professional background in coding, math, statistics, engineering or data science
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training

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.