Claims Quality Analyst

Hi, we're Oscar. We're hiring a Claims Quality Analyst to join our Claims Quality 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 Claims Quality Analyst role is responsible for end to end review of claims quality, communicating deficiencies to the business and obtaining mitigation for errors identified.

You will report to the Claims Quality Control Associate.

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, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, 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: $27.31 - $35.84 per hour. The base pay for this role in all other locations is: $24.58 - $32.26 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 10 days per year

Responsibilities

• Reviewing medical claim reimbursements to ensure accuracy and compliance with relevant policies and regulations.
• Conducting audits of claim processing procedures and systems to identify internal control gaps
• Providing recommendations for process improvements and corrective actions to mitigate future errors.
• Documenting audit findings 
• Participating in training sessions and workshops to enhance knowledge of relevant regulations and industry best practices.
• Monitoring and tracking audit findings and corrective actions to ensure timely resolution and compliance.
• Maintaining up-to-date knowledge of regulatory requirements and industry standards related to claim processing and reimbursement.
• Compliance with all applicable laws and regulations
• Other duties as assigned)

Qualifications

• 2+ years of experience in claims auditing, configuration or provider appeals 

• Experience utilizing CMS resources (i.e. referencing fee schedules and pricers)
• Identifying gaps and communicating them with cross functional stakeholders

Bonus Points

• Experience working with provider contracts or claims configuration