Director Claims Process Improvement

Hi were Oscar. Were hiring a Director Process Improvement 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 Director Process Optimization will lead a team in identifying and implementing training claims process document and process improvement opportunities while ensuring compliance and meeting contractual goals. You will be responsible for developing and implementing an operating plan for improving efficiency scaling operations and ensuring the achievement of departmental performance metrics and goals. The Director will lead and execute key strategic initiatives that not only optimize workflows but also allow Oscar to stay competitive in the market.

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 / 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: $158400 $207900 per year. The base pay for this role in all other locations is: $142560 $187110 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program company equity grants and annual performance bonuses.

Responsibilities

• Maintain responsibility for the continuous improvement of claims processing procedures and ensure adherence to established claims operations procedures throughout the organization
• Lead a team in the optimization of claims process documentation and development and of claims department training
• Collaborate with Operations and Technology team leadership to identify and implement claims system performance strategies
• Lead creation of short and longterm roadmap planning process to meet organization goals identifying important resources and requirements to meet plans goals
• Establish and monitor measures to ensure compliance with industry regulations internal policies and best practice principles around claims processing
• Work with internal tech partners to ensure a coordinated approach in leadership of claims processing training performance monitoring system and process optimization and technology
• Lead coach and develop a highperforming team of managers and their reports
• Develop and continuously improve foundational processes
• Ensure operational compliance with all relevant regulatory/ accreditation agencies and meets contractual requirements
• Lead team to surface data process and technology issues through proactive identification measurement and monitoring of operations; partner cross functionally to develop endtoend strategy that leverages these insights to scale
• Manage develop and maintain relationships crossfunctionally to drive multi department collaboration to drive results for strategic initiatives
• Own team vision and strategy including quarterly vital setting and multiyear roadmap
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• Bachelors Degree in related field or 4 years of commensurate experience
• 10 years of experience in healthcare strategy and operations and or related field
• 6 years of leadership experience
• 2 years of experience in program management and/or process design or implementation
• 10 years of experience in a crossfunctional operations environment
• 3 years of experience working at a health plan/payer

Bonus Points

• Masters degree
• Lean / Six Sigma experience
• Financial modeling experience
• Extensive knowledge of claims operations and processing insurance products contracts and regulatory and policy language
• Experience working with technical teams (i.e. engineering and product) to communicate our requirements design tooling and support technical troubleshooting
• Experience forming datadriven concrete answers in a world with imperfect information
• Proficient in technical writing