Senior Analyst

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

• Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity disputes, 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, summarize and provide input into reimbursement policy language and scope.
• Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever leadership escalates and assigns issues.
• Compliance with all applicable laws and regulations
• Other duties as assigned

• Experience in Payment Integrity focused on Disputes and/or appeals
• 4+ years of experience in claims processing, coding, auditing or health care operations
• 3+ years experience in medical coding
• 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 experience deriving business insights from datasets and solving problems
• 1+ years experience improving business workflows and processes
• 1+ years experience collaborating with internal and external stakeholders

• 2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)
• 2+ years of experience working with large data sets using excel or a database language
• Experience in a professional healthcare claims organization
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training
• Experience using SQL

• Base pay: $64,832 - $85,092 per year
• Eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses
• Remote position open to candidates in Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah