Claims Recovery Specialist

Hi, we're Oscar. We're hiring a Claims Recovery Specialist to join our Payment Integrity 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 Recovery Specialist is responsible for the provider notification, communication and recovery of overpaid claims. You will send notification to providers of the overpayments, follow up with providers via various available communication channels and recover the identified overpayments. You will maintain accurate records of claim status, correspondence, and resolution efforts using designated systems.

You will report to the Senior Manager, Recovery Services.

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, 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: $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

• Analyze, investigate claims date to determine the root cause of an identified overpayment
• Communicate effectively with healthcare providers to recover identified overpayment 
• Prepare and submit notification letters, supporting documentation, and any necessary forms to pursue maximum reimbursement
• Maintain accurate records of claim status, correspondence, and resolution efforts using designated software systems 
• Stay informed about changes in health insurance regulations, coding guidelines, and reimbursement policies to ensure compliance and optimize claim recovery strategies
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 2+ years of experience in claims processing, auditing or health care operations
• 2+ years experience recovery and/or billing experience
• 2+ years of experience working with large data sets using excel or similar

Bonus Points

• 2+ years of related work experience in analytics or operations
• Customer service and/or provider communication experience