Manager, Member & Provider Operational Compliance

The Manager, Member & Provider Operational Compliance at Oscar plays a vital role by ensuring compliance excellence while fostering a culture of operational integrity. In this position, you will develop, implement, and continuously improve operational policies and procedures, and represent the Operations team in discussions with regulatory bodies. Your responsibilities also include proactively identifying compliance issues, collaborating across departments to streamline processes, and training and mentoring team members to enhance their effectiveness.

To be successful as the Manager, Member & Provider Operational Compliance at Oscar, candidates should have 5+ years of relevant experience in an operations role within the health insurance industry, as well as experience representing operational units with regulatory bodies. Additionally, candidates should possess a solid background in developing and managing policies and procedures within healthcare organizations, and experience in team management is crucial.

Oscar prides itself on a blended work culture that fosters connection among its employees, regardless of their work location. For the Manager, Member & Provider Operational Compliance role, team members near the New York City, Tempe, or Los Angeles offices are encouraged to work at least two days a week in the office, while those residing in other approved states can enjoy the flexibility of a remote work-from-home role.

The salary range for the Manager, Member & Provider Operational Compliance position at Oscar varies based on location. In states like California, Connecticut, New Jersey, New York, and Washington, the base pay is between $103,200 and $135,450 per year. For other locations, the pay ranges from $92,880 to $121,905 per year. In addition to competitive pay, Oscar offers employee benefits and the chance to participate in an unlimited vacation program and annual performance bonuses.

In the Manager, Member & Provider Operational Compliance role at Oscar, there are ample opportunities for personal and professional growth. As you take on responsibilities such as developing compliance systems and mentoring team members, you’ll gain valuable experience managing complex business challenges. Oscar also supports further development through knowledge sharing, process documentation, and potential certifications like Lean Six Sigma, enhancing your career trajectory.

When answering this question, focus on specific audits you've participated in and your role in ensuring compliance. Highlight your experience in preparing documentation, coordinating with stakeholders, and addressing any findings that emerged from audit reviews.

Your answer should demonstrate a methodical approach. Discuss how you analyze existing processes, gather input from team members, ensure regulations are met, and implement changes effectively. Providing examples of successful policy development will strengthen your response.

Be prepared to discuss a specific scenario where you detected a compliance gap. Detail your investigative steps, the resolution process, and how you communicated the solution to the relevant teams while ensuring that the issue was fully addressed.

Highlight the importance of communication and training in your answer. Discuss how you would provide regular training sessions, establish open channels for reporting concerns, and recognize team members who promote compliance best practices.

Explain your hands-on mentoring style. Discuss creating tailored training sessions, providing constructive feedback, and encouraging team members to take ownership of compliance responsibilities while supporting them with the necessary resources.

Discuss your experience using data software to analyze compliance trends and how this informs policy development. Explain how data analysis can identify risks and help in making data-driven decisions to enhance compliance practices.

Respond with a specific example of a continuous improvement initiative you've led. Emphasize the steps you took, the challenges you faced, and the outcomes achieved to illustrate your commitment to operational excellence.

Point out that effective communication, building relationships, and aligning goals are essential for collaboration. Provide examples demonstrating your ability to foster teamwork while achieving common compliance objectives.

Explain the resources you use to stay informed, such as industry publications, webinars, and professional associations. Mention your commitment to ongoing education and adapting to regulatory changes to maintain compliance.

Discuss the importance of attention to detail, strong communication skills, and the ability to think critically. Mention your capability to lead a team and adapt to regulatory changes as necessary for success in this role.