Senior Payment Integrity Disputes Specialist - Remote

Oscar Health Insurance; Atlanta (GA); On-site; USD 65,000 - 85,000; Full time

Job summary

Oscar Health Insurance is seeking a Senior Analyst for Payment Integrity Disputes to join the Disputes team. This remote role focuses on supporting payment integrity disputes and driving process improvements within the Oscar claims environment.

You will scope, investigate, and translate stakeholder friction into actionable opportunities, collaborating cross-functionally with internal partners. 4+ years in claims or healthcare operations and medical coding experience are required.

Qualifications

• 4+ years in claims processing, coding, auditing, or healthcare operations.
• Experience with reimbursement policies and provider contracts is required.
• Proficient in analyzing data to identify improvement opportunities.

Responsibilities

• Contribute as SME for reimbursement policies and payment integrity disputes.
• Respond to inquiries and disputes regarding policies and edits.
• Research coding rules and summarize policy language for scope.
• Translate findings into business requirements and collaborate on changes.
• Work with partners to size, prioritize, and deliver solutions.
• Identify themes from data and process monitoring to drive improvements.
• Communicate progress and blockers to stakeholders regularly.
• Support rapid research and root cause analysis when escalated.

Skills

Disputes & Appeals

Claims processing

Medical coding

SQL

Data analysis

Stakeholder collaboration

Process improvement

Lean Six Sigma

Healthcare operations

Excel

Education

Medical coding certification (CPC/COC/AHIMA)

Tools

Excel

Database querying

Job description

Oscar Health Insurance is seeking a Senior Analyst for Payment Integrity Disputes to join the Disputes team. This remote role focuses on supporting payment integrity disputes and driving process improvements within the Oscar claims environment.

You will scope, investigate, and translate stakeholder friction into actionable opportunities, collaborating cross-functionally with internal partners. 4+ years in claims or healthcare operations and medical coding experience are required.