Hi, we're Oscar. We're hiring a Vice President, Senior Claims Expert to join our 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 Vice President, Senior Claims Expert role is responsible for providing decision-making and advisory support to the Claims & Benefits team through extensive industry experience and subject matter expertise. They will be responsible for leading decision-making on critical initiatives and policies, and working through complex strategic and business claims issues, particularly where an industry lens is required. This individual will work cross-functionally with internal teams and engage in external discussions including with Regulators.
You will report to the Senior Vice President, Infrastructure Operations.
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 is: $232,000 - $304,500 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, company equity grants and annual performance bonuses.
Responsibilities
- Provide detailed guidance on Claims & Benefits topics (including implementation of regulations, system logic and configuration, payment methodologies, policies, etc.) based on industry standards and best practices.
- Participate and present the claims industry point of view in internal and external discussions.
- Drive decision-making process on key strategic initiatives and complex business issues.
- Work closely with leaders within Claims & Benefits and across the organization on new policies and strategic initiatives.
- Guide implementation of regulatory and business requirements into workflows and processes.
- Guide implementation and monitoring of key controls.
- Compliance with all applicable laws and regulations.
- Other duties as assigned.
Qualifications
- 15+ years experience in a claims role
- Extensive knowledge of and experience in implementing Claims regulations, payment methodologies and policies
- 5+ years of experience in healthcare operations with an emphasis on designing and reengineering healthcare operational processes
- 5+ years experience in process / workflow building, systems design / configuration, or operational improvement
- 5+ years people management
Bonus Points
- Experience operating in an environment undergoing rapid growth
