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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 to strengthen claims compliance processes and workflows.
The Associate Director will report to the Senior Director, Claims Quality and Compliance and will 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.
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. Cross-functional collaboration is essential, including work with regulatory agencies, legal, audit, and regulatory compliance teams.
The position requires 7+ years of demonstrated experience in claims operations, insurance products, and regulatory/policy language, plus 5+ years of people management and team leadership experience. Candidates should have a proven background collaborating with regulatory agencies and strong familiarity with regulatory requirements, along with the ability to form data-driven answers in situations with imperfect information.
Bonus qualifications include a bachelor's degree, experience with benefit and contract interpretation, managing claims across multiple product types (Medicare, Commercial), process improvement experience, and collaboration with technical teams on requirements and tooling.
