Remote Senior Analyst, Payment Integrity & Claims

Socket.dev; United States; On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonuses

Full benefits

Job summary

Oscar Health is seeking a Senior Analyst to join the Payment Integrity team in a fully remote capacity. The role focuses on supporting process improvement and issue resolution within the Oscar claims environment, translating stakeholder friction into actionable opportunities for improvement.

You will report to the Senior Manager, Payment Integrity. The role requires strong experience in claims processing, medical coding, data insights, and process optimization, with collaborative

Qualifications

• Bachelor’s degree or 4+ years of commensurate experience.
• 4+ years of experience in claims processing, coding, auditing or health care operations.
• 3+ years experience in medical coding within payment integrity.

Responsibilities

• Contribute as a subject matter expert for Oscar reimbursement policies and internal/external edits.
• Respond to inquiries and disputes regarding policies and edits.
• Research industry coding rules and summarize reimbursement policy language.
• Use research and claims review to ideate payment integrity opportunities and translate into business requirements.
• Ingest information from partners to scope, size, prioritize items and deliver solutions.
• Identify thematic opportunities from data and partner submissions to solve problems.
• Keep stakeholders informed of progress and blockers; support leadership as needed.
• Ensure compliance with applicable laws and regulations.

Skills

Claims processing

Medical coding

Data analysis

Workflow improvement

Stakeholder collaboration

SQL

Education

Bachelor's degree

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

Job description

Oscar Health is seeking a Senior Analyst to join the Payment Integrity team in a fully remote capacity. The role focuses on supporting process improvement and issue resolution within the Oscar claims environment, translating stakeholder friction into actionable opportunities for improvement.

You will report to the Senior Manager, Payment Integrity. The role requires strong experience in claims processing, medical coding, data insights, and process optimization, with collaborative