Senior Manager, Payment Integrity

Hi, we're Oscar. We're hiring a Senior Manager 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 Senior Manager, Payment Integrity identifies and prioritizes claims improvement opportunities, sets and holds teams accountable to performance, and develops strategic plans to achieve overall claims outcomes. The Senior Manager plays a critical role in the overall claims improvement apparatus by providing leadership, structure and organization, including coaching and developing direct reports and their teams, in order to enable the team’s success.

You will report to the Senior Director, Payment Integrity.

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: $119,200 - $156,450 per year. The base pay for this role in all other locations is: $107,280 - $140,805 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

• Be the subject matter expert for Claims operations through knowledge and expertise of Oscar’s claim platform, claim regulatory requirements and operational workflows.
• Provide leadership in complex, cross-functional initiatives focused on claims improvement.
• Assist in the oversight of prepay editing vendor relationships.
• Manage inquiries related to vendor edits & disputes.
• Collaborate with internal teams on vendor edits, configuration and overall claims lifecycle as it relates to vendor edits.
• Monitor performance of vendor edits, including but not limited to monthly quality audits.
• Participate in governance committee activities to ensure vendor alignment with internal stakeholders & business decisions.
• Translate a strategic vision for the team and outline clear and measurable performance metrics / OKRs.
• Coach, develop and lead a team to achieve identified outcomes. 
• Manage a portfolio of initiatives and deliverables and proactively identify areas of opportunity to improve key performance indicators.
• Compliance with all applicable laws and regulations 
• Other duties as assigned

Qualifications

• 6+ years experience in operations, healthcare, data analytics and/or consulting
• 6+ years of experience analyzing data to solve complex business problems
• 3+ years of experience leading and developing a team
• 3+ years experience designing, implementing and improving business workflows

Bonus Points

• Experience with healthcare claims processing
• Experience managing in a healthcare claims organization
• 6+ years experience in medical coding
• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
• Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
• Ability to execute on multiple high priority projects within tight deadlines