Operations Associate, Claims Design

Hi, we're Oscar. We're hiring an Operations Associate to join our Claims Design 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

This role is responsible for designing, optimizing and implementing processes and improvements for Oscar’s claims adjudication platform. This person will identify, scope, build, test and implement solutions, with a focus on creating efficiency and scale through technology and automation. They will understand Oscar’s infrastructure, underlying logic, and data models, and will work cross-functionally to understand and translate requirements/rules from business stakeholders to enable technical implementation.

You will report to the Manager, Claims Design.

Work Location:

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, 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.

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $98,400 - $129,150 per year. The base pay for this role in all other locations is: $88,560 - $116,235 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

• Designs and prioritizes operational processes by working cross functionally to gather business requirements and implementing process- and technology-enabled solutions
• Leads and cross collaborates on iterative problem definition and technical design and scoping to build solutions with the end-user in mind
• Utilizes data to independently drive business decisions, impact cross-functional strategy and develop KPIs to measure the effectiveness of your domain
• Serve as a subject matter expert in the claims payments and overpayments process within the claims lifecycle
• Proactively identifies risks; responds to and resolves issues/errors/escalations through data-driven investigation to produce insights for short, medium, and long-term technology-enabled solutions
• Distills the requirements of new product and market expansions and designs automated workflows to reduce manual work requirements
• Works with engineers, analysts and other Operations team members to resolve escalations, develop training, and create technical tooling to enable others
• Understands the operations ecosystem, technology and data models; its current strengths, weaknesses, and gaps; and connects the dots for other teams
• Compliance with all applicable laws and regulations 
• Other duties as assigned

Qualifications

• A bachelor’s degree or 4+ years commensurate experience 
• 3+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering)
• 3+ years experience using data software such as SQL or Python
• Experience in analytics & ability to derive insights from complex, broad datasets 
• Proficiency 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 healthcare or startup environments - specifically with claims adjudication
• Proficiency with Python

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 (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 Notice to Job Applicants.