SlipstreamJobs tracks this role from the company's public career site. Apply directly on the employer's site.
Salary: USD 149,040 - 195,615 / 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.
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 team of claims analysts specializing in 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—you'll work with regulatory agencies, legal, audit, and regulatory compliance teams to develop effective, actionable solutions.
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 experience 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 technical collaboration with engineering and product teams.
The position is based in the New York City office with a hybrid schedule requiring 3 days in-office per week. Thursdays are mandatory for team meetings and events; the other two office days are flexible.
