Hi, we're Oscar. We're hiring a Claims Quality Control Associate to join our Claims Operations team.

Oscar is the first health insurance company built around a full stack technology platform and a 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.

About the role

As a Claims Quality Control Associate, you will be responsible for the end to end claims quality review process and conducting root cause analysis for errors found in monthly claims audits and quality initiatives. You will work in conjunction with the Claims QC Analyst as well as other internal Oscar teams ranging from Operations, Control Operations, finance and technical teams.

You will report to the Senior Manager, Payment Quality.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office ( in Hudson Square), our Tempe office (off the 101 at University Ave), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $93,600 - $122,850 per year. The base pay for this role in all other locations is: $84,240 - $110,565 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Provide subject matter expertise and in-depth understanding of Claims processing workflows.
• Identify claims issues that require action and provide action steps needed to remediate the issue.
• Represent claims in policy discussions and when necessary, document new policies or modifications to existing policies.
• Provide training and education to team members when necessary.
• Act as a subject matter expert using internal and external tools in order to complete audits and provide guidance to team members.
• Act as an in-house expert on data structure and visualization and mediates errors for various stakeholders
• Compliance with all applicable laws and regulations
• Create and maintain documentation for payment integrity workflows
• Other duties as assigned

Qualifications

• 3 years of relevant work experience in claims
• 2 year(s) ability to work independently to drive projects to completion
• 3 years of related work experience in claims processing, analytics and health care operations

Bonus Points

• Bachelor's degree
• Experience with regulatory and third party claims audits
• 2 years of experience working with large data sets using excel or a database language