Remote Associate, Payment Integrity & Claims Analysis

Oscar Health, Inc.; United States; Híbrido; USD 83.000 - 109.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Unlimited vacation

Annual performance bonus

Medical, dental, and vision benefits

Descripción de la vacante

Oscar Health is seeking an Associate on the Payment Integrity team to improve claims processing and reimbursement policies. The role engages across internal and external stakeholders to translate friction into actionable improvements, with a focus on Oscar's claim infrastructure and workflows.

Reporting to the Senior Manager, Payment Integrity, this remote role offers a competitive base salary and benefits, including unlimited vacation and annual performance bonuses, with potential for hybrid

Formación

• Bachelor's degree or 4+ years of commensurate experience.
• 4+ years in claims processing, coding, auditing or health care operations.
• 4+ years of medical coding within payment integrity.
• Certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA).
• Experience with reimbursement methodologies and provider contracts.
• 2+ years deriving business insights from datasets.
• 1+ years improving business workflows and processes.
• 1+ years collaborating with stakeholders.

Responsabilidades

• Provide SME and in-depth understanding of Payment Integrity edits, policies, and reimbursement.
• Respond to inquiries and disputes regarding policies and edits.
• Document coding rules and recommend policy language and scope.
• Identify opportunities and translate into business requirements for change.
• Ingest information from partners to scope, size, prioritize items and deliver solutions.
• Use data and process insights to identify thematic improvement opportunities.
• Keep stakeholders informed on progress and blockers.

Conocimientos

Claims processing

Medical coding

Data analysis

Process improvement

Stakeholder collaboration

SQL

Educación

Bachelor's degree or equivalent

AAPC/AHIMA medical coding certification

Herramientas

SQL

Descripción del empleo

Oscar Health is seeking an Associate on the Payment Integrity team to improve claims processing and reimbursement policies. The role engages across internal and external stakeholders to translate friction into actionable improvements, with a focus on Oscar's claim infrastructure and workflows.

Reporting to the Senior Manager, Payment Integrity, this remote role offers a competitive base salary and benefits, including unlimited vacation and annual performance bonuses, with potential for hybrid