Manager, Complex Issue Resolution
Hi, we're Oscar. We're hiring a Manager, Complex Issue Resolution to join our Claims Production 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 Manager, Claims Issue Resolution leads a team tasked with complex claim analysis and issue resolution with the goal of improving overall claim outcomes across a series of key performance metrics. The Manager plays a critical role in the overall claims improvement apparatus by providing leadership, structure and organization, enabling the team to succeed.
You will report to the Associate Director, Disputes.
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: $103,200 - $129,000 per year. The base pay for this role in all other locations is: $92,880 - $116,100 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.
Responsibilities
- Be the subject matter expert for Claims operations through knowledge and expertise of Oscar's claim platform, claim regulatory requirements and operational workflows
- Lead a team of analysts to conduct root-cause analysis of complex claims issues. Create and suggest plans for correction, overseeing implementation and measuring success. Document and report findings to leadership.
- Manage a team of claims professionals, ensuring quality, accuracy, and compliance in all claims processes. Provide coaching, professional development, and performance management for team members
- Develop team workflows and guidelines that produce consistent and measurable outcomes; train, teach and mentor team members to become more proficient and effective.
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- A bachelor's degree or 4+ years of commensurate experience
- 4+ years leading, coaching and developing direct reports in a healthcare claims organization
- 4+ years of experience analyzing data to solve complex claims problems
- 2+ years experience leading implementation of sustainable and scalable process and workflow improvements
Bonus Points
- Process Improvement or Lean Six Sigma training, certification
- Experience developing project plans in collaboration with internal and external stakeholders
- Experience with healthcare claims processing
- Experience managing in a healthcare claims organization
- Experience with SQL and basic SQL abilities
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 ([email protected]) to make the need for an accommodation known.
Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar.
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.
Average salary estimate
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Oscar Health is an American health insurance company headquartered in New York City. Through telemedicine, healthcare-focused technology interfaces, and clear claims pricing systems, the company focuses on the health insurance market.
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