Hi, we're Oscar. We're hiring a COB Specialist to join our Payment Integrity team.
Oscar is the first health insurance company built around a full stack technology platform and a relentless 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:
You will be responsible for supporting Coordination of Benefits (COB) efforts for Payment Integrity. This role is responsible for investigating and verifying proper payment of Oscar medical and pharmacy claims. You will create new COB workflows, enhance existing and drive COB audits.
You will report into the Manager, Payment Integrity.
Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote
Pay Transparency: The base pay for this role is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
Responsibilities:
- Contribute as a subject matter expert for Oscars COB reimbursement policies
- Respond to internal and external inquiries and disputes regarding COB policies
- Use knowledge gained through research and claims review to ideate COB opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
- Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver COB solutions.
- Use insights from partner submissions, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve COB problems.
- Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
- Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
- Analyze, investigate and confirm if dual coverage exists for Oscar membership
- Utilize data analysis skills and tools to develop accurate, quantitative analyses of payment issues
- Compliance with all applicable laws and regulations
- Other duties as assigned
Requirements:
- A bachelor's degree or 4+ years of commensurate experience
- 4+ years of experience in payment integrity, ideally coordination of benefits
- Experience with coordination of benefits reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
- 2+ years experience deriving business insights from datasets and solving problems
- 1+ years experience improving business workflows and processes
- 1+ years experience collaborating with internal and/or external stakeholders
Bonus points:
- 2+ years of experience working with large data sets using excel or a database language, preferably SQL.
- Experience with pharmacy coordination of benefits
- Experience in a professional healthcare claims organization
- Knowledge management, training, or content development in operational settings
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.
Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
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 ([email protected]) 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 Privacy Policy.
Skills Required
- Bachelor's degree or 4+ years of commensurate experience
- 4+ years of experience in payment integrity, ideally coordination of benefits
- Experience with coordination of benefits reimbursement methodologies, provider contract concepts, and common claims processing and resolution practices
- 2+ years of experience deriving business insights from datasets and solving problems
- 1+ years of experience improving business workflows and processes
- 1+ years of experience collaborating with internal and/or external stakeholders
- 2+ years of experience working with large datasets using Excel or a database language, preferably SQL
- Experience with pharmacy coordination of benefits
- Experience in a professional healthcare claims organization
- Knowledge management, training, or content development in operational settings
Oscar Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Oscar Health and has not been reviewed or approved by Oscar Health.
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Healthcare Strength — Employer-sponsored medical coverage for employees and their families with mental-health support is prominently offered. Wellness programming and digital care access add to perceived strength.
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Parental & Family Support — Paid parental leave of 10+ weeks, backup care, and family-forming support (including fertility and adoption benefits) are part of the package. Reproductive‑loss leave is also noted.
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Leave & Time Off Breadth — Multiple time‑off options, wellness days, and an unlimited vacation program for some roles are described. Paid holidays, paid sick time, and a long‑tenure sabbatical broaden time‑away choices.
Oscar Health Insights
What We Do
Health care is broken; we're trying to fix it. The Oscar team is focused on utilizing technology, design and data to humanize health care. We're a group of technology and health care professionals who looked at the current state of the US health care system, got frustrated by the horrible consumer experience, and decided to do something big about it. Backed by a renowned set of investors and advisors, we’ve set out to revolutionize health care.
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