COB Specialist, Payment Integrity

🔥 15 hours ago

🌽 Illinois, Kentucky, +4 more states – Remote

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

💵 $64.8k - $85.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

🔥 Funding within the last year

💰 $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 Coordination of Benefits (COB) efforts for Payment Integrity • Investigate and verify proper payment of Oscar medical and pharmacy claims • Create new COB workflows and enhance existing workflows • Drive COB audits • Report to the Manager, Payment Integrity • Contribute as a subject matter expert for Oscar's COB reimbursement policies • Respond to internal and external inquiries and disputes regarding COB policies • Research claims and translate COB opportunities into business requirements • Collaborate with internal partners to implement changes • Ingest information regarding adverse claim outcomes and help scope, size, prioritize, and deliver COB solutions • Identify thematic opportunities to solve COB problems • Keep stakeholders informed of progress, status changes, blockers, and completion • Provide research, root cause analysis, and training for escalated issues • Analyze, investigate, and confirm whether dual coverage exists for Oscar members • Use data analysis skills and tools to develop quantitative analyses of payment issues • Perform other duties as assigned

🎯 Requirements

• A bachelor's degree or 4+ years of commensurate experience • 4+ years of experience in payment integrity, ideally coordination of benefits • Experience with coordination of benefits 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 • Compliance with all applicable laws and regulations

🏖️ 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