Manager, Data Mining - Payment Integrity

Oscar Health; New York (NY); Hybrid; USD 112,000 - 147,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonuses

Health, dental and vision insurance

401(k) plan

Paid holidays

Wellness time

Job summary

Oscar Health in New York City is seeking a Manager, Data Mining to lead a specialized team within the Payment Integrity group. You will oversee data mining auditors, manage vendor relationships, and drive savings and recovery initiatives in post-payment processes.

Reporting to the Associate Director, Payment Integrity, you will design workflows, mentor staff, and collaborate with technology and data science to set effective detection algorithms while ensuring compliance with applicable laws.

Qualifications

• Bachelor’s degree or 4+ years of commensurate experience.
• 4+ years experience in healthcare operations.
• 2+ years experience leading and developing a team.
• 2+ years experience designing, implementing and improving business workflows.

Responsibilities

• Oversee the quality control process for data mining vendor submissions, ensuring accuracy and alignment with program standards
• Lead the daily operations of the data mining team, including the strategic delegation of work to both internal auditors and external partners
• Develop team workflows and guidelines that produce consistent and measurable outcomes.
• Train, teach and mentor team members to become more proficient and effective.
• Partner with Oscar's technology and/or data science teams to establish algorithms for savings and recovery identifications.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Skills

Leadership

Healthcare operations

Team development

Workflow design

SQL basics

Education

Bachelor’s degree

Job description

Hi, we're Oscar. We're hiring a Manager, Data Mining to join our Payment Integrity team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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 of Data Mining leads a team of individual contributors, ensuring the team is meeting savings and recovery targets in the payment integrity space. You will lead data mining auditors in the post-payment payment integrity space, and oversee data mining vendor management.

You will report into the Associate Director, Payment Integrity.

Work Location

This position is based in our New York City office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule.

Pay Transparency

The base pay for this role is: $111,780 - $146,711 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Oversee the quality control process for data mining vendor submissions, ensuring accuracy and alignment with program standards
• Lead the daily operations of the data mining team, including the strategic delegation of work to both internal auditors and external partners
• Develop team workflows and guidelines that produce consistent and measurable outcomes.
• Train, teach and mentor team members to become more proficient and effective.
• Partner with Oscar's technology and/or data science teams to establish algorithms for savings and recovery identifications.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements

• A bachelor’s degree or 4+ years of commensurate experience
• 4+ years experience in healthcare operations
• 2+ years experience leading and developing a team
• 2+ years experience designing, implementing and improving business workflows

Bonus Points

• 2+ years of payment integrity experience at a health plan or vendor organization
• Experience with healthcare claims adjudication
• Experience with SQL and basic SQL abilities
• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)

This is an authentic Oscar Health job opportunity.

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.

Artificial Intelligence (AI)

Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

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.

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