Senior Analyst, Payment Integrity Disputes at Oscar Health

New York, New York, United States -

Full Time

Start Date

Immediate

Expiry Date

28 Jun, 26

Salary

94547.0

Posted On

30 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Payment Integrity, Disputes, Claims Processing, Issue Resolution, Workflow Tooling, Data Models, Reimbursement Policies, Claims Auditing, Medical Coding, Root Cause Analysis, Business Requirements, Data Mining, Process Improvement, Stakeholder Collaboration, SQL, Excel

Industry

Insurance

Description

Hi, we're Oscar. We're hiring a Senior Analyst, Payment Integrity Disputes to join our Disputes team. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: You will be responsible for supporting payment integrity disputes and issue resolution in the Oscar claim environment for both the Oscar Insurance business. You will scope, triage, investigate and execute on solutions and process improvements. You will leverage a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally and understand and translate friction from stakeholders into actionable opportunities for improvement. You will report into the Manager, Payment Integrity (Pre-Pay). Work Location: This position is based in our New York City office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid Pay Transparency: The base pay for this role is: $72,036 - $94,547 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity disputes, internal claims processing edits and external vendor edits. Respond to internal and external inquiries and disputes regarding policies and edits. Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope. Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change. Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions. Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems. Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate. Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever leadership escalates and assigns issues. Compliance with all applicable laws and regulations Other duties as assigned Requirements: Experience in Payment Integrity focused on Disputes and/or appeals 4+ years of experience in claims processing, coding, auditing or health care operations 3+ 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. 2+ years experience deriving business insights from datasets and solving problems 1+ years experience improving business workflows and processes 1+ years experience collaborating with internal and external stakeholders Bonus points: 2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar) 2+ years of experience working with large data sets using excel or a database language Experience in a professional healthcare claims organization Knowledge management, training, or content development in operational settings Process Improvement or Lean Six Sigma training Experience using SQL This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

Responsibilities

The Senior Analyst will support payment integrity disputes and issue resolution within the Oscar claim environment, taking responsibility for scoping, triaging, investigating, and executing solutions and process improvements. This role involves acting as a subject matter expert on policies and edits, responding to inquiries, researching industry standards, and translating insights into actionable business requirements for internal partners.