Associate Director, Claims Compliance

🕒 Outubro 30

🤠 Texas – Remoto

🤠 Texas – Remote

💵 $134.136 - $176.053 / ano

⏰ Tempo Integral

🟠 Sênior

🚔 Conformidade

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Oscar Health

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2012

⚕️ Seguro de Saúde

🏥 Saúde

💰 $355.000.000 Post-IPO Debt - Oscar Health em 2025-09

Healthcare Insurance • Healthcare

Oscar é uma agência de recrutamento STEM de classe mundial que oferece soluções de talentos líderes do setor. A empresa opera em seis marcas, conectando talentos de ponta com empresas em vários setores, incluindo tecnologia, construção, ciências da vida e energia renovável. Com escritórios ao redor do mundo, Oscar é reconhecida como uma das cinco melhores empresas para se trabalhar e está comprometida em oferecer excelência em serviços de recrutamento.

Descrição

• Direct and coordinate aspects of Oscar claims processes, including research, adjustments, and regulatory inquiries • Lead a team of claims analysts specializing in regulatory compliance, investigating regulatory inquiries and developing external responses • Influence sensitive complex situations and departmental strategy using industry knowledge and quantitative and qualitative inputs • Translate the claims department's strategy into business plans and tactics to meet operational KPIs, targets and SLAs • Create structure to achieve programmatic and departmental goals • Use business and industry knowledge to inform strategy and execution • Supervise and train managers and employees as needed • Collaborate with other departments on claims issues, related projects and inter-departmental operations issues • Manage processes and interdepartmental initiatives to ensure timely results or issue resolution • Collaborate with regulatory agencies and Oscar's legal, audit, and regulatory compliance teams • Ensure compliance with all applicable laws and regulations • Perform other duties as assigned • Report to the Senior Director, Claims Quality and Compliance

🎯 Requisitos

• 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 • 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 requirements, design tooling, and support technical troubleshooting • Excellent leadership and communication skills to drive decision-making and results across multiple partners

🏖️ Benefícios

• Employee benefits • Unlimited vacation program • Annual performance bonuses • Medical benefits • Dental benefits • Vision benefits • 11 paid holidays • Paid sick time • Paid parental leave • 401(k) plan participation • Life and disability insurance • Paid wellness time and reimbursements

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