Associate Director, Claims Disputes

Hi, we're Oscar. We're hiring an Associate Director, Claims Disputes 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 ourselves—one that behaves like a doctor in the family.

About the role

The Associate Director, Disputes leads a team of production leaders that are responsible for managing open provider claim dispute inventory ensuring accurate and timely resolution reducing provider abrasion and limiting interest payments. This role will be responsible for producing/managing/reporting on key performance indicators that drive the business and mitigate risk.

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 / 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: $144,000 - $189,000 per year. The base pay for this role in all other locations is: $129,600 - $170,100 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

• Direct and coordinate aspects of Oscar provider claims disputes processing including but not limited to: research, adjustments, regulatory inquiries and escalations from providers
• Ensure team achieves industry standard KPIs for quality and productivity
• Ensure all provider claims dispute policies and procedures reflect outcome based results to reduce provider abrasion and maintain the highest quality standards
• Identify and implement process improvements by using dispute data to track and trend claims processing issues
• Leverages industry background and knowledge of processes to influence others in complex situations
• Collaborate and communicate with other departments on claims issues, related projects and inter-departmental operations issues while developing effective, actionable solutions.
• Manage open provider claim dispute  inventory and mitigation of interest bearing claims payment
• Responsible for ongoing career development of the team by  maintaining culture, employee satisfaction and team performance management.
• Develop annual and ad-hoc training program for team members and managers
• Compliance with all applicable laws and regulations 
• Other duties as assigned

Qualifications

• 7+ years of experience in claims operations including adjudication, adjustments and inventory management
• 5+ years of people management and team leadership experience with ability to prioritize, allocate work and manage across multiple high-value projects at once
• 3+ years of experience with benefit and contract interpretation or coding in professional/ institutional billing requirements
• 3+ years of experience managing claims across multiple product types (i.e. Medicare or Commercial)
• 3+ years of experience analyzing and improving processes and workflows
• 5+ years of experience working with technical teams (e.g. engineering and product) in translating business requirement specifications

Bonus Points

• Bachelor's degree, or 4 years commensurate experience
• CPC or other professional coding certification
• Experience in making data-driven decisions in a fast paced environment
• Excellent leadership and communication skills to drive decision-making and results across multiple partners.