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Salary: USD 64,832 - 85,092 / annual
Oscar Health is seeking a Senior Analyst, Payment Integrity to support process improvement and issue resolution within the claims environment for Oscar Insurance and Oscar clients. This role is responsible for organizing, scoping, investigating, and executing solutions and process improvements within payment integrity edits and ideation.
You will leverage deep understanding of Oscar's claims infrastructure, workflows, tooling, platform logic, and data models to work cross-functionally with stakeholders. You will translate friction points into actionable improvement opportunities.
Key responsibilities include:
- Serve as a subject matter expert on Oscar reimbursement policies, internal claims processing edits, and external vendor edits
- Respond to internal and external inquiries and disputes regarding policies and edits
- Research industry standard coding rules and provide input into reimbursement policy language and scope
- Ideate payment integrity opportunities based on research and claims review; translate into business requirements and collaborate with internal partners to effectuate change
- Ingest information from internal and external partners regarding adverse claim outcomes; collaborate to scope, size, prioritize, and deliver solutions
- Proactively identify thematic areas of opportunity using insights from partner submissions, data mining, and process monitoring
- Maintain transparency and collaboration by keeping stakeholders informed of progress, status changes, blockers, and completion
- Support Oscar run state objectives by providing research, root cause analysis, and training when issues are escalated
- Ensure compliance with all applicable laws and regulations
You will report 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. Future work models may involve hybrid presence at the hub office associated with your metro area.
Requirements:
- Bachelor's degree or 4+ years of commensurate experience
- 4+ years of experience in claims processing, coding, auditing, or healthcare operations
- 3+ 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
- Experience using SQL
