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Manager, Complex Claims

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Hi, we're Oscar. We're hiring a Manager, Complex Claims to join our Claims Production 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

The Manager, Complex Claims is responsible for the engagement, development, and results of a team driving Claims Production Processing. The Manager plays a critical role in Claims production to ensure that Oscar members' claims are processed in a timely and accurate manner.

You will report to the Associate Director, Claims Production.

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 Dr), 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, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, 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: $88,800 - $116,550 per year. The base pay for this role in all other locations is: $79,920 - $104,895 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

Adjudicate highly complex claims with technical complexity and coordination ensuring claims are processed timely and accurately
Lead teams for the review of highly specialized claims processing including: high cost claims, transplants, COB and other third-party insurance
Conducting detailed information gathering, analysis and investigation to find solutions, and reporting to senior leaders on complex claims trends and developments
Conduct file reviews to ensure accuracy
Ensure team meets daily, monthly and annual production goals and performance objectives for both quality and productivity
Creating, tracking, and implementing best practices for Production Management to improve overall member experience through daily queue management and production tracking.
Utilize frameworks to intentionally develop and coach your team in order to build future leaders within the organization
Take a proactive, forward-thinking and data-driven approach to identify concerns, inefficiencies, and operational improvement initiatives throughout the Claims space that drive desired cultural and operational outcomes
Compliance with all applicable laws and regulations
Other duties as assigned

Qualifications

Bachelor's degree or 4 years of commensurate experience
4+ years of experience leading, coaching and developing direct reports in a healthcare claims production environment
3+ years of experience with using data and metrics to problem solve and drive root cause analysis

Bonus Points

Proficiency in Microsoft Office Suite
Process Improvement or Lean Six Sigma training, certification
Experience as a leader in a remote environment
Experience in BPO or Call Center environments

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.

Oscar Health Glassdoor Company Review

3.2

Oscar Health DE&I Review

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CEO of Oscar Health

Mark Bertolini

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Average salary estimate

$98235 / YEARLY (est.)

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$79920K

$116550K

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What You Should Know About Manager, Complex Claims, Oscar Health

Welcome to Oscar! We’re excited to offer the role of Manager, Complex Claims within our dynamic Claims Production team. At Oscar, we're not just any health insurance company; we pride ourselves on being the first to build our services around a cutting-edge technology platform focused on delivering the best member experiences. Launched in 2012, our mission has always been to create a health insurance model that feels more like a caring doctor than a faceless corporation. As the Manager of Complex Claims, you’ll be the driving force behind a team that handles intricate claims processing, ensuring that our members' claims are managed efficiently and accurately. You’ll be reporting to the Associate Director of Claims Production and working in a remote setting, part of our blended work culture. If you’re located near our New York City, Tempe, or Los Angeles offices, you can enjoy a hybrid work experience, while everyone else works remotely. The role involves leading reviews of high-cost claims, utilizing data analysis for trends, and implementing best practices to enhance member experiences. You’ll have the opportunity to nurture future leaders through intentional coaching, while also meeting production goals. With a focus on compliance and a dedication to improvement, you'll be integral to our mission. So, if you’re passionate about transforming the healthcare landscape, we’d love for you to join us at Oscar!

Frequently Asked Questions (FAQs) for Manager, Complex Claims Role at Oscar Health

What are the main responsibilities of the Manager, Complex Claims at Oscar?

As a Manager, Complex Claims at Oscar, your primary responsibilities include leading a team that processes complex claims with a focus on accuracy and timeliness. You’ll adjudicate high complexity claims and coordinate with third-party insurance when necessary. Additionally, analyzing data to identify trends, conducting file reviews, and ensuring the team meets specific productivity goals are crucial aspects of your role.