Manager, Complex Claims

Oscar Health; United States; Hybrid; USD 92,000 - 129,000; Full time

Job summary

Oscar Health, a leading health insurance technology company, is hiring a Manager for Complex Claims to enhance claims outcomes through effective leadership and strategy implementation. This role involves managing specialized claims, coaching team members, and ensuring regulatory compliance, offering a dynamic workspace with significant growth potential and flexible work options.

Benefits

Unlimited vacation program

Medical, dental, and vision benefits

401(k) plan participation

Life and disability insurance

Qualifications

• 4+ years leading and developing direct reports in a claims environment.
• 4+ years analyzing data to solve complex claims problems.
• 2+ years designing and improving business workflows.

Responsibilities

• Lead and mentor teams on complex claims processing.
• Manage a portfolio of initiatives for improving key performance indicators.
• Conduct analysis and report on claims trends.

Skills

Data analysis

Process Improvement

Education

Bachelor's degree

4+ years of claims experience

Job description

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Hi, we're Oscar. We're hiring a Manager, Complex Claims 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, Complex Claims leads a team tasked with tactical and strategic initiatives with the goal of improving complex 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, Claims Production.

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.

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
• Manage a complex portfolio of initiatives and deliverables and proactively identify areas of opportunity to improve key performance indicators
• Develop team workflows and guidelines that produce consistent and measurable outcomes; train, teach and mentor team members to become more proficient and effective.
• Lead teams for the review of highly specialized claims processing including: high cost claims, transplants, COB and other third-party insurance
• Conducting detailed information gathering, analysis and investigation to find solutions, and reporting to senior leaders on complex claims trends and developments
• 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 claims environment
• 4+ years of experience analyzing data to solve complex claims problems
• 2+ years experience designing, implementing and improving business workflows
  
  

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
  
  

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 ([e-mail]) 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.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  Insurance

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