Associate Director, Claims Compliance

Oscar Health•Tempe, AZ

2d•Hybrid

About The Position

Oscar is seeking a Claims Compliance Associate Director to join their Claims team. This role leads a team of analysts responsible for investigating and responding to regulatory inquiries and market conduct exams. The position ensures adherence to state and federal regulations, works directly with regulators, and partners across Insurance Operations and other departments to strengthen claims compliance. The Associate Director is expected to transform ideas into implementation to improve claims compliance and regulatory performance. This role reports 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.

Nice To Haves

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 (e.g. engineering and product) to communicate requirements, design tooling, and support technical troubleshooting.
Excellent leadership and communication skills to drive decision-making and results across multiple partners.

Responsibilities

Direct and coordinate aspects of Oscar claims processes including research, adjustments, and regulatory inquiries.
Lead a team of claims analysts specializing in regulatory compliance, tasked with investigating regulatory inquiries and developing external responses.
Leverage industry background and knowledge of processes to influence others in sensitive complex situations while preserving relationships.
Significantly influence departmental strategy by providing quantitative and qualitative inputs that drive organization success.
Translate the claims department's strategy into business plans and tactics to meet operational KPIs, targets and SLAs.
Create necessary structure to achieve programmatic and departmental goals.
Understand and use business and industry knowledge to inform strategy and execution.
Supervise and train managers and employees as needed.
Collaborate and communicate with other departments on claims issues, related projects and inter-departmental operations issues while developing effective, actionable solutions.
Effectively manage processes and inter departmental initiatives through a collaborative approach to ensure timely results or issue resolution.
Work cross collaboratively with various regulatory agencies, as well as Oscar's legal, audit, and regulatory compliance teams.
Ensure compliance with all applicable laws and regulations.
Perform other duties as assigned.