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Salary: USD 64,832 - 85,092 / annual
Oscar Health is seeking a COB (Coordination of Benefits) Specialist to join the Payment Integrity team. This role is responsible for investigating and verifying proper payment of Oscar medical and pharmacy claims, creating new COB workflows, enhancing existing processes, and driving COB audits.
You will serve as a subject matter expert on Oscar's COB reimbursement policies, responding to internal and external inquiries and disputes. Key responsibilities include analyzing claim data to identify dual coverage situations, conducting root cause analysis on payment issues, and collaborating with internal and external partners to scope and prioritize COB solutions. You will translate research insights into business requirements and work with stakeholders to implement changes.
The role requires strong data analysis capabilities—you'll utilize tools to develop quantitative analyses of payment issues and identify thematic opportunities for process improvement. You'll maintain transparency with stakeholders by providing regular updates on progress, blockers, and completion status. Additionally, you'll support operational objectives by providing research, training, and escalation support as needed.
This is a fully remote position open to candidates residing in Atlanta, Chicago, Dallas, Louisville, Minneapolis, Philadelphia, or Salt Lake City. You will report to the Manager of Payment Integrity. The role requires a bachelor's degree or 4+ years of equivalent experience, plus 4+ years in payment integrity (ideally COB), knowledge of COB reimbursement methodologies and claims processing, 2+ years deriving business insights from data, and experience improving workflows and collaborating cross-functionally. Bonus qualifications include SQL/Excel proficiency, pharmacy COB experience, healthcare claims background, and knowledge management expertise.
