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Salary: USD 82,717 - 108,566 / annual
Oscar Health is seeking an Associate, Payment Integrity to support process improvement and issue resolution within the claims environment for Oscar Insurance and Oscar clients. This role organizes, scopes, prepares, investigates, and executes solutions and process improvements within payment integrity edits and ideation by leveraging deep understanding of Oscar's claims infrastructure, workflows, tooling, platform logic, and data models.
You will work cross-functionally to translate stakeholder friction into actionable improvement opportunities. Key responsibilities include: providing subject matter expertise on payment integrity internal and external claims processing edits and reimbursement policies; responding to internal and external inquiries and disputes; documenting industry standard coding rules and recommending policy language; ideating payment integrity opportunities based on coding knowledge and translating them into business requirements; ingesting information from partners regarding adverse claim outcomes and collaborating to scope, size, and prioritize solutions; proactively identifying thematic improvement areas; maintaining stakeholder communication on progress and status; supporting run-state objectives through research, root cause analysis, and training; and ensuring compliance with applicable laws and regulations.
The role reports to the Senior Manager, Payment Integrity. This is a fully remote position open to candidates residing in Atlanta, GA; Chicago, IL; Dallas, TX; Louisville, KY; Minneapolis, MN; Philadelphia, PA; or Salt Lake City, UT. While currently remote, Oscar's work model may evolve to include hybrid presence at hub offices in the future.
**Requirements:**
- Bachelor's degree or 4+ years of commensurate experience
- 4+ years of experience in claims processing, coding, auditing, or healthcare operations
- 4+ years of experience in medical coding within payment integrity
- Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
- Experience with reimbursement methodologies, provider contract concepts, and common claims processing/resolution practices
- 2+ years of experience deriving business insights from datasets and solving problems
- 1+ years of experience improving business workflows and processes
- 1+ years of experience collaborating with internal and/or external stakeholders
**Bonus qualifications:**
- 2+ years in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or process improvement role (Six Sigma or similar)
- Process Improvement or Lean Six Sigma training
- SQL experience
