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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 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 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.
You will leverage industry background and knowledge to influence others in sensitive, complex situations while preserving relationships, significantly influencing departmental strategy through quantitative and qualitative inputs. The role requires supervising and training managers and employees, collaborating with other departments on claims issues and inter-departmental operations, and working cross-collaboratively with regulatory agencies, legal, audit, and compliance teams.
Required qualifications include 7+ years of demonstrated experience in claims operations, insurance products, and regulatory/policy language; 5+ years of people management and team leadership with ability to prioritize and manage multiple high-value projects; proven background collaborating with regulatory agencies; and experience forming data-driven answers with imperfect information. Bonus qualifications include a bachelor's degree, experience with benefit/contract interpretation, managing claims across multiple product types (Medicare, Commercial), process improvement analysis, and collaboration with technical teams.
