Associate, Payment Policy

Hi were Oscar. Were hiring a Payment Policy Associate to join our Payment Integrity 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 ourselvesone that behaves like a doctor in the family.

About the role :

The Payment Policy Associate manages and executes all payment policy activities including organizing scoping investigating and resolving payment policy issues. Responsibilities also involve delegating and prioritizing project tasks effectively. This work relies on internal team research and a thorough understanding of Oscars claim infrastructure to draft and update payment policies accurately.

You will report into the Manager Payment Policy.

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 : $82717 - $108566 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program and annual performance bonuses.

Responsibilities :

• Provide subject matter expertise and in-depth understanding of Payment Integrity internal claims processing edits external vendor edits and Oscar reimbursement policies.
• Analyze data mining and process monitoring to pinpoint claims payment issues then define the scope and steps for policy remediation.
• Examine industry standards to confirm claim payments align with industry best practices internal policies and regulationsboth industry-wide and Oscar-specific.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Document industry standard coding rules and draft recommendations on reimbursement policy language and scope.
• Ideate payment integrity opportunities based on a deep knowledge of industry standard coding rules. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
• Attend regulation update meetings and relay information to team members providing training and education as needed.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress status changes blockers completion etc.; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research root cause analysis training etc. whenever issues are escalated and assigned by leadership.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements :

Bonus points :

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here .

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. Were 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 applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () 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 .

Required Experience :

IC

Key Skills

Maitre,JAVA / J2EE,Invasive Cardiology,Fire Alarm Installation,Evening

Employment Type : Full-Time

Experience : years

Vacancy : 1

Yearly Salary Salary : 82717 - 108566