Senior Manager, Compliance Audit and Monitoring

Hi, we're Oscar. We're hiring a Senior Manager, Compliance Audit and Monitoring to join our Compliance 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 Senior Manager, Compliance Audit and Monitoring leads the enterprises' compliance programs and activities. You will oversee the development, and management of all delegation oversight activities and compliance programs to align with healthcare regulatory requirements. You will lead a team of Associates, you will evaluate requirements and assessing compliance, understanding and execution from multiple perspectives, including training materials, production tooling, standard operating procedures, business practices and historical external communications regarding process.

You will report to the Director, Regulatory Audit & Reporting.

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: $131,200 - $172,200 per year. The base pay for this role in all other locations is: $118,080 - $154,980 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Strategize and lead delegation oversight and internal compliance activities with all partners.
• Develop and implement a risk-based audit and monitoring plan for the healthcare organization.
• Manage audit tools and conduct training to impart knowledge to staff and organization.
• Ensure delegate and team adherence to contractual, regulatory, and accreditation requirements.
• Lead the compliance audit and monitoring team, providing guidance and direction to ensure successful execution of audit plans and risks are identified and mitigated.
• Ensure compliance with healthcare regulations, including HIPAA, Medicare, and Medicaid regulations.
• Develop relationships with departmental leaders to understand business operations, identify areas of risk, and provide guidance on internal control design and implementation.
• Evaluate the effectiveness of existing controls and develop risk assessment models to focus on, and prioritize, high-risk areas.
• Establish key performance indicators (KPIs) for delegated entities and internal processes
• Approve audit and compliance monitoring reports, ensuring the quality of the audit findings and conclusions.
• Implement and monitor corrective action plans for areas of non-compliance
• Provide regular updates to executive management and the Board of Directors on compliance audit and monitoring activities and findings.
• Oversee the execution of internal and delegate audits and ensure timely audit planning and completion.
• Provide strategic guidance and direction to departmental teams on compliance matters.
• Delegate tasks to departmental leads to ensure timely compliance actions.
• Establish and maintain compliance policies, procedures, and controls in alignment with regulatory requirements.
• Compliance with all applicable laws and regulation
• Other duties as assigned

Qualifications

• Bachelor's degree or commensurate work experience
• 6+ years working with payer experience
• 6+ years in leading direct reports and teams
• 4+ years experience working in health care or related field with Procedures
• 4+ years driving compliance with regulatory and accreditation audit/policy requirements
• 4+ years Experience working with regulation and translating into operational procedures
• 4+ years Experience managing several critical, external facing, deliverables simultaneously
• 4+ years Experience in implementation, program building, and maintenance

Bonus Points

• Certification in Healthcare Compliance (CHC), Certified Compliance and Ethics Professional CCEP, or similar
• Fluency with State DOI audit and/or reporting obligations
• State DOI audit management experience
• Experience in a startup and/or health tech environment
• Experience in a TPA setting