Manager, Data Mining – Payment Integrity

🔥 15 hours ago

🌽 Illinois, Kentucky, +4 more states – Remote

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

💵 $100.6k - $132k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📊 Data Scientist

🦅 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

• Lead a team of individual contributors and ensure savings and recovery targets are met • Lead data mining auditors in the post-payment payment integrity space • Oversee data mining vendor management • Oversee quality control for data mining vendor submissions • Lead daily data mining team operations and strategically delegate work to internal auditors and external partners • Develop team workflows and guidelines producing consistent, measurable outcomes • Train, teach and mentor team members • Partner with technology and/or data science teams to establish algorithms for savings and recovery identification • Comply with applicable laws and regulations • Perform other duties as assigned • Report to the Associate Director, Payment Integrity

🎯 Requirements

• A bachelor’s degree or 4+ years of commensurate experience • 4+ years experience in healthcare operations • 2+ years of experience leading and developing a team • 2+ years experience designing, implementing and improving business workflows • Bonus: 2+ years of payment integrity experience at a health plan or vendor organization • Bonus: Experience with healthcare claims adjudication • Bonus: Experience with SQL and basic SQL abilities • Bonus: Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)

🏖️ 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