Associate Director Claims Process Optimization

Hi were Oscar. Were hiring an Associate Director Process Optimization 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 ourselvesone that behaves like a doctor in the family.

About the role

The Associate Director Process Optimization is responsible for designingand implementing processes and improvements for configuring Oscars technology stack to optimize claims processing and increasing overall claims payment quality.You will lead a team to identify scope build test and implement solutions with a focus on creating efficiency and scale through technology and automation.

You will report to the Director Claims Process Optimization.

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 / workfromhome role.

You must reside in one of the following states: Alabama Arizona Arkansas California Colorado Connecticut Florida Georgia IllinoisIndiana 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. #LIRemote

Pay Transparency:

The base pay for this role in the states of California Connecticut New Jersey New York and Washington is: $144000 $189000 per year. The base pay for this role in all other locations is: $129600 $170100 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program and annual performance bonuses.

Responsibilities

• Develop foundational processes for our scaling claims operations and summarize the complexity of Claims data and operations into clear explanations
• Develop business requirements operational improvements to Oscars claims processes to ensure compliance improve scalability and manage risks
• Collaborate with internal teams and external vendors and partners to deliver on expansion and platform targets and key operational metrics
• Surface data process and technology issues through proactive identification measurement and monitoring of claims operations
• Partner closely with Product & Engineering and/or Data Science orgs to deliver the next generation of health insurance operations
• Work with collaborators within the Claims team and partners across the rest of Insurance Operations and crossfunctionally to ensure the successful launch of new markets lines of business and partnerships by the target launch date for Oscars full portfolio.
• Through Oscars infrastructure underlying logic and data models this role works crossfunctionally to understand and translate requirements/rules from business stakeholders to enable technical implementation.
• Identify either process or training deficiencies through the review of audit results provider disputes provider complex escalations and other claims payment trends and implement changes to correct
• Owns team strategy and influences department level strategy
• Owns designs and prioritizes technical operations roadmaps working cross functionally to gather business requirements in order to implement and improve the efficacy and efficiency of existing operational processes or to unlock new platform capabilities
• Utilizes data to independently drive business decisions impact crossfunctional strategy and develop KPIs to measure the effectiveness of your domain
• Proactively identify risks; responds to and resolves issues/errors/escalations through datadriven investigation to produce insights for short medium and longterm technologyenabled solutions
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• A bachelors degree or 4 years commensurate experience
• 7 years of experience in health plan operations health insurance and/or data analysis or consulting in the healthcare space
• 7 years of experience using data software such as Excel SQL or Python
• 4 years of experience building coaching and developing technical or operational teams
• 3 years of experience in analytics & ability to derive insights from complex broad datasets
• 3 yearsof experience in designing and improving workflows as well as standing up accompanying operating and technical procedures

Bonus Points

• An academic and professional background in coding math statistics engineering or data science
• Knowledge management training or content development in operational settings
• Process Improvement or Lean Six Sigma training
• Experience in health plan administration configuration