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Senior Director, Claims Quality

Oscar Health

Oscar Health

Sales & Business Development, Quality Assurance
Remote
Posted on Tuesday, August 29, 2023

Hi, we're Oscar. We're hiring a Senior Director, Claims to join our Operations 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

As the Senior Director of Claims, this role is responsible for continuous improvement and compliance of claims operations, processes and systems. Responsible for establishing a best in class standard for claims operational performance at Oscar, you will grow and lead a team of colleagues focused on claims quality and optimization.

You will report to the VP, Claims Operations.

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 Ave), 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: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, 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: $192,000 - $252,000. The base pay for this role in all other locations is: $172,800 - $226,800 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants, and annual performance bonuses.

Responsibilities

  • Evaluate in detail current claims operations from start to finish and analyze processes to identify and design process improvement strategies
  • Collaborate with Operations and Technology team leadership to identify and implement claims system performance strategies
  • Lead creation of short- and long-term roadmap planning process to meet organization goals, identifying important resources and requirements to meet plans' goals
  • Establish and set checks to ensure compliance with industry regulations, internal policies and best practice principles around claims processing are being followed
  • Identify claims processing risks and implement measures to maintain claims performance
  • Oversee monitoring of claims processing to ensure that claims processing meets performance metrics around quality, member and provider satisfaction.
  • Oversee the investigation and settlement of high-value and complex claims.
  • Work with internal tech partners to ensure a coordinated approach in leadership of claims processing, training, performance monitoring, system and process optimization and technology
  • Maintain responsibility for the continuous improvement of claims processing procedures and ensure adherence to established claims operations procedures throughout the organization
  • Be the point person on claims remediation plans and ensuring teams follow best practice principles around claims processing and policy/process to affect organizational change to improve efficiency and quality
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Qualifications

  • A bachelor's degree or commensurate 4 years of experience
  • 15+ years experience in a cross-functional operations environment
  • 3+ years of experience working at a health plan/payer
  • Extensive knowledge of claims operations and processing, insurance products, contracts, and regulatory and policy language
  • Experience analyzing and improving processes and workflows
  • Experience working with technical teams (i.e. engineering and product) to communicate our requirements, design tooling, and support technical troubleshooting
  • People management skills and team leadership experience with ability to prioritize, allocate work and manage across multiple high-value projects at once
  • Experience forming data-driven, concrete answers in a world with imperfect information
  • Excellent leadership and communication skills to drive decision-making and results across multiple partners

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 (accommod[email protected]) to make the need for an accommodation known.