Associate Director, Claims Compliance
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What you'll do
- Direct and coordinate aspects of Oscar claims processes including but not limited to: research, adjustments, and regulatory inquiries.
- Lead a team of claims analysts specializing in regulatory compliance, tasked with investigating regulatory inquiries and developing external responses.
- Leverages industry background and knowledge of processes to influence others in sensitive complex situations while preserving relationships.
- Significantly influences departmental strategy by providing quantitative and qualitative inputs that drive organization success.
- Translates the claims department's strategy into business plans and tactics in order to meet operational KPIs, targets and SLAs.
- Creates necessary structure to achieve programmatic and departmental goals.
- Understands and uses business and industry knowledge to inform strategy and execution.
- Supervise and train managers and employees as needed.
- Collaborate and communicate with other departments on claims issues, related projects and inter-departmental operations issues while developing effective, actionable solutions.
- Effectively manage processes and inter departmental initiatives through a collaborative approach to ensure timely results or issue resolution.
- Work cross collaboratively with various regulatory agencies, as well as Oscar's legal, audit, and regulatory compliance teams.
- Compliance with all applicable laws and regulations.
What they're looking for
- 7+ years of demonstrated experience in claims operations and processing, insurance products, and regulatory and policy language.
- 5+ years of people management and team leadership experience with ability to prioritize, allocate work and manage across multiple high-value projects at once.
- Proven background collaborating with regulatory agencies and strong familiarity with regulatory requirements.
- Experience forming data-driven, concrete answers in a world with imperfect information.
Nice to have
- Bachelor's degree, or 4 years commensurate experience.
- Experience with benefit and contract interpretation or coding in professional/ institutional billing requirements.
- Experience managing claims across multiple product types ( i.e.Medicare or Commercial).
- Experience analyzing and improving processes and workflows.
- Experience working with technical teams (e.g. engineering and product) to communicate our requirements, design tooling, and support technical troubleshooting.
- Excellent leadership and communication skills to drive decision-making and results across multiple partners.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
Hi, we're Oscar. We're hiring a Claims Compliance Associate Director to join our Claims team.
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the role:
The Associate Director, Claims Compliance leads a team of analysts responsible for investigating and responding to regulatory inquiries, including market conduct exams. This role is responsible for ensuring adherence to state and federal regulations, working directly with regulators on exams and investigations, and partnering across Insurance Operations and cross-functionally to ensure processes and workflows are in place to strengthen claims compliance. The Associate Director transforms ideas from vision to implementation, with the goal of improving claims compliance and regulatory performance.
You will report into the Senior Director, Claims Quality and Compliance.
Work Location: This position is based in our Tempe, Arizona office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid
Pay Transparency: The base pay for this role is:$134,136 - $176,053 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses
Responsibilities:
- Direct and coordinate aspects of Oscar claims processes including but not limited to: research, adjustments, and regulatory inquiries.
- Lead a team of claims analysts specializing in regulatory compliance, tasked with investigating regulatory inquiries and developing external responses.
- Leverages industry background and knowledge of processes to influence others in sensitive complex situations while preserving relationships. Significantly influences departmental strategy by providing quantitative and qualitative inputs that drive organization success.
- Translates the claims department's strategy into business plans and tactics in order to meet operational KPIs, targets and SLAs.
- Creates necessary structure to achieve programmatic and departmental goals.
- Understands and uses business and industry knowledge to inform strategy and execution.
- Supervise and train managers and employees as needed.
- Collaborate and communicate with other departments on claims issues, related projects and inter-departmental operations issues while developing effective, actionable solutions.
- Effectively manage processes and inter departmental initiatives through a collaborative approach to ensure timely results or issue resolution.
- Work cross collaboratively with various regulatory agencies, as well as Oscar's legal, audit, and regulatory compliance teams.
- Compliance with all applicable laws and regulations.
- Other duties as assigned.
Requirements:
- 7+ years of demonstrated experience in claims operations and processing, insurance products, and regulatory and policy language.
- 5+ years of people management and team leadership experience with ability to prioritize, allocate work and manage across multiple high-value projects at once.
- Proven background collaborating with regulatory agencies and strong familiarity with regulatory requirements.
- Experience forming data-driven, concrete answers in a world with imperfect information.
Bonus points:
- Bachelor's degree, or 4 years commensurate experience.
- Experience with benefit and contract interpretation or coding in professional/ institutional billing requirements.
- Experience managing claims across multiple product types ( i.e.Medicare or Commercial).
- Experience analyzing and improving processes and workflows.
- Experience working with technical teams (e.g. engineering and product) to communicate our requirements, design tooling, and support technical troubleshooting.
- Excellent leadership and communication skills to drive decision-making and results across multiple partners.
This is an authentic Oscar Health job opportunity.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.
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