Associate, Payment Integrity (Data Mining)
About The Position
Hi, we're Oscar. We're hiring an Associate, Data Mining to join our Payment Integrity team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: The Associate, Data Mining ensures payment integrity data mining programs are running smoothly and effectively. The Associate is a subject matter expert for the team and a key stakeholder in facilitating vendor and internal payment integrity programs. The Associate, Data Mining provides thought leadership for processes and workflows that impact payment integrity and improve data mining solutions.
Requirements
- 3+ years of experience in claims processing, auditing or health care operations.
- 3+ years of experience in building or supporting data mining payment integrity solutions.
- Proven ability to work independently to drive projects to completion.
- Some coding experience or database language exposure
Nice To Haves
- Bachelor’s degree
- 3+ years of related work experience in analytics or operations
- Experience with claims pricing algorithms and/or software
- Experience using SQL
Responsibilities
- Provide subject matter expertise and in-depth understanding of data mining workflows and program rules.
- Identify payment integrity solution issues that require action and provide steps needed to remediate the issue.
- Identify claims with post-payment errors and facilitate processes to recover payments and ensure future payment accuracy
- Represent data mining payment integrity solutions in payment policy discussions and when necessary, document new policies or modifications to existing policies.
- Provide training and education to team members when necessary.
- Serve as a subject matter expert using internal and external tools in order to complete audits and provide guidance to team members.
- Serve as an in-house expert on data structure and visualization for various stakeholders in service operations.
- Facilitate quality review and validation of data mining concepts and overpayment identifications
- Compliance with all applicable laws and regulations.
- Other duties as assigned
Benefits
- employee benefits
- participation in Oscar's unlimited vacation program
- annual performance bonuses
- medical, dental, and vision benefits
- 11 paid holidays
- paid sick time
- paid parental leave
- 401(k) plan participation
- life and disability insurance
- paid wellness time and reimbursements
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Number of Employees
1,001-5,000 employees
