Senior Analyst, Payment Integrity Disputes

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🔥 0 minutes 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

🟠 Senior

🧐 Analyst

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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 payment integrity disputes and issue resolution in Oscar’s claims environment • Scope, triage, investigate, and execute solutions and process improvements • Leverage knowledge of claims infrastructure, workflows, workflow tooling, platform logic, and data models • Work cross-functionally to translate stakeholder friction into actionable improvement opportunities • Contribute as a subject matter expert on reimbursement policies, payment integrity disputes, claims processing edits, and vendor edits • Respond to internal and external inquiries and disputes • Research industry-standard coding rules and provide input into reimbursement policy language and scope • Ideate payment integrity opportunities and translate them into business requirements • Collaborate with internal partners to effectuate changes • Ingest adverse claim outcome information, scope and prioritize issues, and deliver solutions • Identify thematic opportunities through partner submissions, data mining, and process monitoring • Keep stakeholders informed of progress, status changes, blockers, and completion • Provide research, root cause analysis, and training for escalated issues • Comply with applicable laws and regulations • Perform other duties as assigned

🎯 Requirements

• Experience in Payment Integrity focused on disputes and/or appeals • 4+ years of experience in claims processing, coding, auditing, or health care operations • 3+ years of experience in medical coding • 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 of experience deriving business insights from datasets and solving problems • 1+ years of experience improving business workflows and processes • 1+ years of experience collaborating with internal and external stakeholders

🏖️ 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