Associate, Payment Integrity

🔥 14 minutes ago

🌽 Illinois, Kentucky, +4 more states – Remote

🌽 Illinois – Remote 🐎 Kentucky – Remote ❄️ Minnesota – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote ⛷️ Utah – Remote

💵 $82.7k - $108.6k / year

⏰ Full Time

🟡 Mid-level

🦅 H1B Visa Sponsor

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

• Support process improvement and issue resolution in the Oscar claim environment for Oscar Insurance and +Oscar clients • Organize, scope, prepare, investigate and/or execute solutions and process improvements within edits and ideation • Leverage Oscar’s claim infrastructure, workflows, workflow tooling, platform logic and data models • Work cross-functionally to translate stakeholder friction into actionable improvement opportunities • Provide subject matter expertise on Payment Integrity claims processing edits, external vendor edits and Oscar reimbursement policies • Respond to internal and external inquiries and disputes regarding policies and edits • Document industry-standard coding rules and recommend reimbursement policy language and scope • Ideate payment integrity opportunities, translate them into business requirements and collaborate with internal partners to implement change • Ingest partner information regarding adverse claim outcomes; scope, size, prioritize and deliver solutions • Use partner submissions, data mining and process monitoring to identify thematic opportunities • Keep stakeholders informed of progress, status changes, blockers and completion • Provide research, root cause analysis and training for escalated issues • Comply with all applicable laws and regulations • Perform other duties as assigned

🎯 Requirements

• A bachelor’s degree or 4+ years of commensurate experience • 4+ years of experience in claims processing, coding, auditing or health care operations • 4+ years experience in medical coding within payment integrity • Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA) • Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices • 2+ years experience deriving business insights from datasets and solving problems • 1+ years experience improving business workflows and processes • 1+ years experience collaborating with internal and/or external stakeholders • Process Improvement or Lean Six Sigma training is a bonus • Experience using SQL is a bonus

🏖️ 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 and reimbursements