Manager, Data Mining - Payment Integrity

Namely; Tempe (AZ); Hybrid; USD 101,000 - 132,000; Full time

Job summary

Oscar Health is seeking a Manager, Data Mining to lead the Payment Integrity team in Tempe. You will guide a team of auditors, oversee data mining vendor management, and drive savings and recovery targets in post-payment processes.

This role reports to the Associate Director, Payment Integrity and requires a hybrid schedule with 3 in-office days per week, including Thursdays for team meetings and events. Qualifications include 4+ years in healthcare operations and prior leadership experience;

Qualifications

• Bachelor’s degree or 4+ years of commensurate experience.
• 4+ years of 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

Team mentoring

Workflow design

Data-driven decision making

Education

Bachelor's degree or 4+ years experience

Tools

SQL

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 Tempe, Arizona 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. #LI-Hybrid

Pay Transparency: The base pay for this role is: $100,602- $132,040 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 of 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)

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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.

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