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Associate Director, Claims Process Optimization

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Hi, we're Oscar. We're hiring an Associate Director, Process Optimization to join our Claims 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 Associate Director, Process Optimization is responsible for designing and implementing processes and improvements for configuring Oscar’s technology stack to optimize claims processing and increasing overall claims payment quality. You will lead a team to identify, scope, build, test and implement solutions, with a focus on creating efficiency and scale through technology and automation.

You will report to the Director, Claims Process Optimization.

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: $144,000 - $189,000 per year. The base pay for this role in all other locations is: $129,600 - $170,100 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

Develop foundational processes for our scaling claims operations and summarize the complexity of Claims data and operations into clear explanations
Develop business requirements operational improvements to Oscar’s claims processes to ensure compliance, improve scalability, and manage risks
Collaborate with internal teams and external vendors and partners to deliver on expansion and platform targets and key operational metrics
Surface data, process, and technology issues through proactive identification, measurement, and monitoring of claims operations
Partner closely with Product & Engineering and/or Data Science orgs to deliver the next generation of health insurance operations
Work with collaborators within the Claims team and partners across the rest of Insurance Operations and cross-functionally to ensure the successful launch of new markets, lines of business, and partnerships by the target launch date for Oscar’s full portfolio.
Through Oscar’s infrastructure, underlying logic, and data models this role works cross-functionally to understand and translate requirements/rules from business stakeholders to enable technical implementation.
Identify either process or training deficiencies through the review of audit results, provider disputes, provider complex escalations and other claims payment trends and implement changes to correct
Owns team strategy and influences department level strategy
Owns, designs and prioritizes technical operations roadmaps working cross functionally to gather business requirements in order to implement and improve the efficacy and efficiency of existing operational processes or to unlock new platform capabilities
Utilizes data to independently drive business decisions, impact cross-functional strategy and develop KPIs to measure the effectiveness of your domain
Proactively identify risks; responds to and resolves issues/errors/escalations through data-driven investigation to produce insights for short, medium, and long-term technology-enabled solutions
Compliance with all applicable laws and regulations
Other duties as assigned

Qualifications

A bachelor’s degree or 4 years commensurate experience
7+ years of experience in health plan operations, health insurance, and/or data analysis or consulting in the healthcare space
7+ years of experience using data software such as Excel, SQL or Python
4+ years of experience building, coaching and developing technical or operational teams
3+ years of experience in analytics & ability to derive insights from complex, broad datasets
3+ years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures

Bonus Points

An academic and professional background in coding, math, statistics, engineering or data science
Knowledge management, training, or content development in operational settings
Process Improvement or Lean Six Sigma training
Experience in health plan administration configuration

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

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CEO of Oscar Health

Mark Bertolini

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Average salary estimate

$159300 / YEARLY (est.)

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$129600K

$189000K

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What You Should Know About Associate Director, Claims Process Optimization, Oscar Health

Hey there! We're Oscar, and we're on the lookout for a dynamic Associate Director of Claims Process Optimization to join our passionate Claims team. Since our inception in 2012, we have been on a mission to transform health insurance through innovative technology and stellar service. As the Associate Director, you'll play a pivotal role in revolutionizing how we process claims by designing and implementing smart solutions that enhance efficiency and ensure quality. Leading a collaborative team, you’ll dive deep into the intricacies of our claims operations, identifying areas for improvement, and developing robust processes that will scale with Oscar's exciting growth. With a focus on leveraging technology and automation, you'll be a key player in refining our internal systems while working closely with Product, Engineering, and Data Science teams. This is not just a job; it's an opportunity to influence the future of health insurance from the comfort of your home or one of our vibrant offices in New York, Tempe, or Los Angeles. Here at Oscar, we value creativity and collaboration, ensuring everyone feels connected, regardless of their work location. Plus, we believe in work-life balance—highlighted by our unlimited vacation policy. If you have the experience and passion to make a real difference, we’d love to hear from you!

Frequently Asked Questions (FAQs) for Associate Director, Claims Process Optimization Role at Oscar Health

What are the responsibilities of the Associate Director, Claims Process Optimization at Oscar?

The Associate Director, Claims Process Optimization at Oscar plays a vital role in improving our claims processing operations. Responsibilities include designing operational workflows, collaborating with various teams, conducting data analysis, and leading initiatives to enhance the scalability and compliance of our claims processes. You'll manage strategies to surface and address issues in claims operations, ensuring that your team consistently meets operational metrics.