- Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
- Utilize data analysis skills and tools to develop accurate, quantitative analyses of issues.
- Translate observations, findings and analysis results into detailed–often technical–business requirements; submit to and collaborate with internal partners to effectuate change.
- Provide occasional subject matter expertise support on external provider calls
- Surface and escalate potential high-impact/global issues and work as an advocate for solutions
- Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve 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.
- Compliance with all applicable laws and regulations
- Other duties as assigned
- A bachelor's degree or 4+ years of commensurate experience
- 2+ years experience deriving business insights from large datasets and solving problems
- 1+ years experience improving business workflows and processes
- 1+ years experience in claims processing or billing within a healthcare organization
- 1+ years experience collaborating with internal and/or external stakeholders
- Experience using SQL
- An academic and/or professional background in engineering, data, or healthcare
- Knowledge management, training, or content development in operational settings
- Process Improvement or Lean Six Sigma training ands
- 2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)
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Senior Analyst, Claims Account Services - Tempe, United States - Oscar Health
Description
Job Description
Job DescriptionHi, we're Oscar. We're hiring a Senior Analyst to join our Claims Account Services 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 roleThis role is responsible for supporting process improvement and issue resolution in the Oscar claim environment for the Oscar Insurance business. The Senior Analyst, Claims Account Services role organizes, scopes, triages, investigates and/or executes on solutions and process improvements for claims issues raised by our P&L and provider partners. This is accomplished by conducting root-cause analysis and working cross-functionally with the appropriate teams to improve workflows, workflow tooling, platform logic, claims adjudication logic, and any other systemic or behavioral issues impacting claims payment.
You will report to the Manager - Claims Account Services.
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: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, 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: $72,800 - $95,550 per year. The base pay for this role in all other locations is: $65,520 - $85,995 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
ResponsibilitiesThis 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 ) to make the need for an accommodation known.
