Associate Director – Claims Compliance

🔥 1 hour ago

🇺🇸 United States – Remote

💵 $134.1k - $176.1k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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This company has sponsored H1B visas in the past.

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

💰 $355M Post-IPO Debt - Oscar Health on 2025-09

Healthcare Insurance • Healthcare

Oscar Health is a technology-driven health insurance company that provides individual, family, and small-group health plans in multiple U. S. states. Oscar combines traditional insurance underwriting with digital-first services — a consumer-facing app, 24/7 virtual urgent care, prescription delivery (including $3 meds in many plans), and dedicated Care Teams — and also operates Oscar Primary Care in some markets. The company emphasizes accessible, affordable, high-quality care and uses AI to improve member experience and care delivery. Insurance policies are underwritten by Oscar's state insurance subsidiaries and the company offers both HMO and other plan types across its markets.

📋 Description

• Direct and coordinate aspects of Oscar claims processes, including research, adjustments, and regulatory inquiries • Lead a team of claims analysts investigating regulatory inquiries and developing external responses • Influence sensitive, complex situations and provide quantitative and qualitative inputs to departmental strategy • Translate claims 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 departments on claims issues, 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 applicable laws and regulations • Report to the Senior Director, Claims Quality and Compliance

🎯 Requirements

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

🏖️ Benefits

• 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 insurance • Disability insurance • Paid wellness time • Wellness reimbursements

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