Director, Claims and Benefits Configuration

Oscar Health; United States; Remote; USD 156,000 - 229,000; Full time

Job summary

A leading health insurance company is seeking a Director of Claims and Benefits Configuration to lead a team focused on managing plan and benefit configuration. This role involves collaboration with various teams to improve operational processes and drive business decisions through data analysis. The ideal candidate has extensive experience in health plan operations and team development.

Benefits

Unlimited vacation program

Company equity grants

Annual performance bonuses

Qualifications

• 10+ years experience in health plan operations or healthcare data analysis.
• 7+ years of experience building and developing technical teams.

Responsibilities

• Lead and develop a high-performing team.
• Owns and prioritizes Configuration operations roadmaps.
• Oversee data utilization for business decisions.

Skills

Leadership

Data Analysis

Problem Solving

Education

Bachelor's Degree

Tools

Lean Six Sigma

Job description

Hi, we're Oscar. We're hiring a Director, Claims and Benefits Configuration 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

As Director of Claims and Benefits Configuration, you will lead a team responsible for managing plan and benefit configuration across the organization. Your key responsibilities include developing and leading execution of the plan and benefit configuration roadmap and collaborating with Insurance Product and Technology teams, as well as the broader Insurance Operations organization, to perform ongoing configuration activities and build scalable solutions to improve the configuration space.

You will report to the Senior Director, Claims Design & Benefits

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: $174,400 - $228,900 per year. The base pay for this role in all other locations is: $156,960 - $206,010 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities

• Lead, coach and develop a high-performing team
• Creates team strategy and participates in setting department level strategy
• Owns and prioritizes Configuration operations roadmaps working cross functionally to gather business requirements in order to implement and improve the efficacy and efficiency of existing operational processes or to unlock new platform capabilities
• Oversee the utilization of data to independently drive business decisions, drive cross-functional strategy and develop KPIs to measure the effectiveness of your domain
• Proactively identify and review risks; oversee responses to and resolutions to issues/errors/escalations through data-driven investigation to produce insights for short, medium, and long-term technology-enabled solutions
• Provides expertise and works across departments and with senior leadership to solve organizational issues
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• A bachelor’s degree or 4 years commensurate experience
• 10+ years experience in health plan operations, health insurance, and/or data analysis or consulting in the healthcare space
• 7+ years of experience building, coaching and developing technical or operational teams within healthcare
• 6+ years experience in analytics & ability to derive insights from complex, broad datasets
• 6+ years in designing and improving workflows as well as standing up accompanying operating and technical procedures
• Experience in health plan configuration, specifically benefit concepts

Bonus Points

• An academic and professional background in coding, math, statistics, engineering or data science
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training
• Working knowledge of contract and rate configuration