Remote Senior Analyst, Payment Integrity & Disputes

Oscar Health; United States; On-site; USD 65,000 - 85,000; Full time

Job summary

Oscar Health is seeking a Senior Analyst for Payment Integrity Disputes to join our Disputes team. You will support payment integrity disputes and issue resolution within the Oscar claim environment, scoping, triaging, investigating, and implementing improvements.

This remote role is open to candidates across the United States, with potential future hybrid options at metro-area hubs. You will collaborate with cross-functional partners to drive solutions while ensuring compliance with applicable

Qualifications

• 4+ years of claims processing, coding, auditing or health care operations.
• 3+ years experience in medical coding.
• Experience with reimbursement methodologies and common claims processing practices.
• 2+ years deriving business insights from datasets and solving problems.
• 1+ years improving business workflows and processes.
• 1+ years collaborating with internal and external stakeholders.

Responsibilities

• Contribute as a subject matter expert for reimbursement policies, payment integrity disputes, internal and external edits.
• Respond to inquiries and disputes regarding policies and edits.
• Research industry standard coding rules and summarize input for policy language.
• Translate research and claims review into business requirements for internal partners.
• Ingest information from partners to 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 completion.

Skills

Payment integrity

Disputes & appeals

Data analysis

Stakeholder collaboration

Root cause analysis

Process improvement

Education

Medical coding certification (AAPC/AHIMA)

Tools

SQL

Excel

Job description

Oscar Health is seeking a Senior Analyst for Payment Integrity Disputes to join our Disputes team. You will support payment integrity disputes and issue resolution within the Oscar claim environment, scoping, triaging, investigating, and implementing improvements.

This remote role is open to candidates across the United States, with potential future hybrid options at metro-area hubs. You will collaborate with cross-functional partners to drive solutions while ensuring compliance with applicable