Remote Payment Integrity Associate — Process Improvement

Oscar-Health-; Arizona; Remote; USD 83,000 - 109,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonus

Medical, dental, and vision benefits

Job summary

Oscar Health is hiring an Associate to join the Payment Integrity team. This remote role supports process improvements and issue resolution within Oscar's claim environment, working cross-functionally to translate friction into actionable improvements.

You will report to the Senior Manager, Payment Integrity, and may work remotely from multiple U.S. metro areas. Base pay ranges from $82,717 to $108,566 per year, with benefits and performance bonuses.

Qualifications

• Bachelor’s degree or 4+ years relevant experience.
• 4+ years in claims processing, coding, auditing, or healthcare operations.
• 4+ years medical coding in payment integrity.
• Certification CPC/COC or CCS/RHIT/RHIA.
• Experience with reimbursement methodologies and provider contracts.
• 2+ years deriving insights from datasets or solving problems.
• 1+ years improving business workflows and processes.
• 1+ years collaborating with internal and/or external stakeholders.
• 2+ years in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma).
• Lean Six Sigma training & proficiency.

Responsibilities

• Provide SME and deep understanding of Payment Integrity edits and policies.
• Respond to inquiries and disputes regarding policies and edits.
• Document industry coding rules and recommend policy language and scope.
• Ideate payment integrity opportunities and translate into business requirements.
• Ingest information from partners and scope, size, prioritize items and deliver solutions.
• Use data mining and process monitoring to identify opportunities to solve problems.
• Keep stakeholders informed of progress, blockers and status changes.
• Support run state objectives with rapid research and root cause analysis when escalated.
• Ensure compliance with applicable laws and regulations.
• Perform other duties as assigned.

Skills

Claims processing

Medical coding

Data analysis

SQL

Process improvement

Stakeholder collaboration

Lean Six Sigma training

Education

Bachelor's degree

Medical coding certification (CPC/COC or CCS/RHIT/RHIA)

Job description

Oscar Health is hiring an Associate to join the Payment Integrity team. This remote role supports process improvements and issue resolution within Oscar's claim environment, working cross-functionally to translate friction into actionable improvements.

You will report to the Senior Manager, Payment Integrity, and may work remotely from multiple U.S. metro areas. Base pay ranges from $82,717 to $108,566 per year, with benefits and performance bonuses.