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Salary: USD 134,136 - 176,053 / annual
Oscar Health is seeking an Associate Director, Claims Compliance to lead a team of analysts responsible for investigating and responding to regulatory inquiries, including market conduct exams. This role ensures adherence to state and federal regulations, works directly with regulators on exams and investigations, and partners across Insurance Operations and cross-functionally to strengthen claims compliance processes and workflows.
You will report to the Senior Director, Claims Quality and Compliance and be responsible for directing and coordinating aspects of Oscar's claims processes, including research, adjustments, and regulatory inquiries. Key responsibilities include leading a specialized team of claims analysts focused on regulatory compliance, translating departmental strategy into business plans and tactics to meet operational KPIs and SLAs, and creating necessary structure to achieve programmatic goals.
The role requires leveraging industry background and knowledge to influence others in sensitive, complex situations while preserving relationships. You will significantly influence departmental strategy by providing quantitative and qualitative inputs that drive organizational success. Collaboration is essential—you'll work cross-functionally with various regulatory agencies, legal, audit, and regulatory compliance teams to develop effective, actionable solutions.
Responsibilities include supervising and training managers and employees, managing inter-departmental initiatives through collaborative approaches, and ensuring compliance with all applicable laws and regulations. The ideal candidate has 7+ years of claims operations and processing experience, 5+ years of people management and team leadership experience, proven background collaborating with regulatory agencies, and strong familiarity with regulatory requirements. Experience with benefit and contract interpretation, managing claims across multiple product types, and working with technical teams is a plus.
The position is based in Tempe, Arizona, with a hybrid work schedule requiring 3 days in-office per week. Thursdays are mandatory for team meetings and events; the other two office days are flexible.
