Associate Director, Claims Production

Hi, we're Oscar. We're hiring a Associate Director, Claims Production to join our Claims 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

In this role, you will lead a team of production leaders that are responsible for managing open claim inventory, claim payment timeliness, and producing/managing/reporting on key performance indicators that drive the business and mitigate risk.

You will report to the Senior Director, Claims.

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, 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: $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

• Manage open claim inventory and mitigation of interest bearing claims payment
• Oversee cross functional claims divisions including but not limited to: production, adjustment, and disputes work units
• Collaborate with business leaders and internal stakeholders to set strategy, align on organization structure, and evaluate people-based business decisions
• Direct and coordinate aspects of Oscar claims processes including but not limited to: research, adjustments, and regulatory inquiries or escalations from providers
• Leverages industry background and knowledge of processes to influence others in complex situations. Significantly influences departmental strategy by providing quantitative and qualitative inputs that drive organization success.
• Translates the claims department’s strategy into business plans and tactics in order to meet operational KPIs, targets and SLAs.
• Creates necessary structure to achieve programmatic and departmental goals
• Understands and uses business and industry knowledge to inform strategy and execution
• Collaborate and communicate with other departments on claims issues, related projects and inter-departmental operations issues while developing effective, actionable solutions.
• Effectively manage processes and inter departmental initiatives through a collaborative approach to ensure timely results or issue resolution.
• Work cross collaboratively with various regulatory agencies, as well as Oscar’s legal, audit, and regulatory compliance teams.
• Responsible for ongoing career development of the team, maintaining culture and employee satisfaction. Supervise and train managers and employees as needed.
• Compliance with all applicable laws and regulations
• Other duties as assigned 

Qualifications

• 7+ years of experience in claims operations including adjudication, adjustments and inventory management
• 5+ years of people management and team leadership experience with ability to prioritize, allocate work and manage across multiple high-value projects at once
• 3+ Experience with benefit and contract interpretation or coding in professional/ institutional billing requirements. 
• 3+ Experience managing claims across multiple product types (i.e. Medicare or Commercial)
• 3+ Experience analyzing and improving processes and workflows
• 5+ Experience working with technical teams (e.g. engineering and product) in translating business requirement specifications 

Bonus Points

• Bachelor's degree, or 4 years commensurate experience
• CPC or other professional coding certification
• Experience in making data-driven decisions in a fast paced environment
• Excellent leadership and communication skills to drive decision-making and results across multiple partners