Claims Compliance Associate Director - Regulatory Leader

Oscar Health; New York (NY); On-site; USD 150,000 - 210,000; Full time

Benefits offered by this job

null

Job summary

Oscar Health is seeking an Associate Director, Claims Compliance to lead a team of analysts focused on regulatory inquiries and exams. The role drives adherence to state and federal rules, partnering across Operations to strengthen claims compliance and performance.

You will report to the Senior Director, Claims Quality and Compliance, translating vision into actionable programs, and guiding cross-department initiatives to timely results and issue resolution.

Qualifications

• 7+ years of experience in claims operations and processing.
• Experience with regulatory agencies and regulatory requirements.
• 5+ years of people management and team leadership.
• Bachelor's degree or 4 years commensurate experience.
• Experience with benefit and contract interpretation or coding in professional/institutional billing.
• Experience managing claims across Medicare or Commercial products.
• Experience analyzing and improving processes and workflows.
• Experience collaborating with technical teams (engineering/product) to communicate requirements.

Responsibilities

• Lead a team of claims analysts specializing in regulatory compliance and investigations.
• Direct and coordinate aspects of Oscar claims processes including research and regulatory inquiries.
• Collaborate with regulators, Oscar's legal, audit, and regulatory compliance teams.
• Translate strategy into business plans to meet KPIs, targets and SLAs.
• Supervise and train managers and employees as needed.
• Influence departmental strategy with quantitative and qualitative insights.

Skills

Regulatory compliance

Leadership

Claims operations

Cross-functional collaboration

Data-driven decisions

Communication

Education

Bachelor's degree or equivalent experience

Job description

Oscar Health is seeking an Associate Director, Claims Compliance to lead a team of analysts focused on regulatory inquiries and exams. The role drives adherence to state and federal rules, partnering across Operations to strengthen claims compliance and performance.

You will report to the Senior Director, Claims Quality and Compliance, translating vision into actionable programs, and guiding cross-department initiatives to timely results and issue resolution.