Hi, we're Oscar. We're hiring a Utilization Review Processor to join our Utilization 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
You will process prior authorizations within regulatory turn around times. This role communicates with our Providers, um clinicians and works collaboratively with teams across Oscar to provide efficient and resolution by providing world class service. The processor understands the importance of a world-class member and provider experience when seeking care and actively identifies barriers to member care and member and provider satisfaction to solve for the future. They are able to meet hourly performance metrics consistently by adhering to task assignments and outreaching for assistance when challenges or roadblocks arise.
You will report to the.Utilization Operations Manager.
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: $21.11 per hour. The base pay for this role in all other locations is: $19.00 per hour. You are also eligible for employee benefits, monthly vacation accrual at a rate of 10 days per year and annual performance bonuses.
Responsibilities
- Manage queue work and and assigned task through efficient dashboard management
- Process tickets within determined SLAs and regulatory turn around times
- Collaborate with colleagues, Specialists and Leads to identify trends and roadblocks
- Utilize internal tools and resources seamlessly
- Effectively communicates findings and resolutions with providers and internal departments
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- 1 year of customer support/service experience
Bonus Points
- Advanced computer literacy skills with experience using CRM and knowledge management tools to resolve client issues
- Experience using ticket management and reporting tools
- Experience managing an assignment caseload
- Customer service experience
- Healthcare and/or SAAS experience
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.
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 ([email protected]) 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 Notice to Job Applicants.
What We Do
Healthcare is broken; we're trying to fix it. The Oscar team is focused on utilizing technology, design and data to humanize healthcare. We're a group of technology and healthcare professionals who looked at the current state of the US healthcare system, got frustrated by the horrible consumer experience, and decided to do something big about it.
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