Associate Director, Claims Compliance

Oscar Health•Atlanta, GA

2d•$134,136 - $176,053•Remote

About The Position

The Associate Director, Claims Compliance leads a team of analysts responsible for investigating and responding to regulatory inquiries, including market conduct exams. This role is responsible for ensuring adherence to state and federal regulations, working directly with regulators on exams and investigations, and partnering across Insurance Operations and cross-functionally to ensure processes and workflows are in place to strengthen claims compliance. The Associate Director transforms ideas from vision to implementation, with the goal of improving claims compliance and regulatory performance. You will report into 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 our 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 but not limited to: research, adjustments, and regulatory inquiries.
Lead a team of claims analysts specializing in regulatory compliance, tasked with investigating regulatory inquiries and developing external responses.
Leverages industry background and knowledge of processes to influence others in sensitive complex situations while preserving relationships. Significantly influences departmental strategy by providing quantitative and qualitative inputs that drive organization success.
Translates the claims department's strategy into business plans and tactics in order to meet operational KPIs, targets and SLAs.
Creates necessary structure to achieve programmatic and departmental goals.
Understands and uses 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.
Compliance with all applicable laws and regulations.
Other duties as assigned.