Hi, we're Oscar. We're hiring a UM Manager Regulatory Operations to join our Utilization Management Optimization 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 Manager, UM Regulatory Operations works with a team of leaders, project managers, and Partners to solve business problems related to internal processes. You will identify critical processes and risks to the business, defining the business’ requirements, partnering with Compliance and Legal teams to assess risk, and overseeing the implementation of required changes to process and/or technology. The Manager, UM Regulatory Operations supports our teams in driving an outstanding, service-focused operation by driving strategic compliance with all regulatory requirements.
You will report to the Director UM Optimization.
This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote
The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $108,000- $141,750 per year. The base pay for this role in all other locations is: $97,200 - $127,575per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
Responsibilities
- Be the example of the continuous improvement mindset, providing direction and influence, while demonstrating actual results of organizational behavior change in this area
- Demonstrate the proper approach with implementation of Continuous Improvement Tools both internal to our organization and aligned to industry best practices
- Partner with several leaders in all areas of the business to support the move towards core operational improvements
- Utilize and implement programmatic frameworks and tools while adjusting your approach based on measured outcomes across simultaneous projects
- Oversee foundational stability and ensuring scalability within your responsibilities
- Monitor and mitigate risks to UM business in the regulatory landscape
- Be a primary contact for UM business with Compliance, Legal, and external audit teams
- Provide clear context, in the form of Business Requirements Documents (BRDs), process maps, standard operating procedures and policy documents to define expectations from process and technology changes
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- A bachelor's degree or 4+ years commensurate experience
- 4+ years of work experience in operations, health insurance, data analysis, engineering and/or consulting
- 3+ years of experience using data software such as Excel, SQL, Python or other data analytics tools
- 3+ years of experience with end to end project management
- 3+ years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures
- 3+ years of experience with process improvement methodologies such as Lean, Six Sigma and/or Theory of constraints
Bonus Points
- Bachelor’s degree in Engineering, Business Administration, Policy or other related field
