Hi, we're Oscar. We're hiring an Associate, Member & Provider Compliance to join our Insurance Operations team.
Oscar is the first health insurance company built around a full stack technology platform and a 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, Member & Provider Compliance will play a crucial tactical role in supporting compliance within Member and Provider Operations by analyzing challenges, coordinating responses, and delivering positive outcomes based on inputs from stakeholders. You will advance compliance efforts by conducting detailed data analysis, managing document reviews, overseeing the delivery of Market Conduct Exam exhibits/narratives and the policies & procedures review process within Operations.
You will report to the Manager, Member & Provider Compliance.
Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.
If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.
You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote
Pay Transparency:
The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $93,600 - $122,850 per year. The base pay for this role in all other locations is: $84,770 - $110,565 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
Responsibilities
- Collaborate with team members and senior leaders to address process gaps and improvements.
- Perform data pulls and conduct detailed analysis to support compliance initiatives.
- Develop trusting relationships with internal and external stakeholders through effective communication and collaboration.
- Draft detailed narratives and reports to communicate compliance findings and updates, including responses to Regulator/NCQA requests and examinations.
- Oversee the Policies & Procedures review process within Operations, ensuring that all policies and procedures are up-to-date and meet internal requirements as outlined by Compliance team.
- Support Oscar team members through knowledge sharing, process documentation, and tooling development
- Assist in preparing for Market Conduct Exams and other regulatory reviews.
- Stay informed on business requirements and act on regulatory updates guided by Oscar’s Compliance team to ensure adherence to effective processes and procedures
- Other duties as assigned
- Compliance with all applicable laws and regulations
Qualifications
- Demonstrated understanding of Member (including Appeals & Grievances) & Provider operations in the health payer industry.
- 3+ years of relevant experience working with operational compliance, regulatory, and data analysis within the healthcare industry.
- 3+ years experience working with regulatory bodies and Market Conduct Exams
- 3+ years experience designing and improving workflows
Bonus Points
- Experience managing complicated business challenges: developing understanding, distilling and communicating that understanding to technical and non-technical audiences.
- An academic and professional background in engineering, data, or healthcare
- Knowledge management, training, or content development in operational settings
- Process Improvement or Lean Six Sigma certification
- Structured, systematic, and critical thinking
- Strong verbal and written communications
- 3+ years experience using data software (e.g. Excel, VGA, Macros, SQL and/or Python) to manipulate and analyze large data sets to solve business problems
