Associate, Payment Integrity

Oscar Insurance Company • Los Angeles, CA

115d • $88,800 - $116,550 • Remote

About The Position

The Associate, Payment Integrity is responsible for leading Coordination of Benefits efforts within the claims and Payment Integrity space. This is accomplished by leveraging a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc. The Associate provides thought leadership for Payment Integrity Coordination of Benefits processes and workflows. The Associate leverages industry-standard knowledge and proven practices in Coordination of Benefits (COB) auditing to identify overpayments, prevent inaccurate claim adjudication, and support overall payment integrity.

Requirements

• A bachelor's degree or 4+ years of commensurate experience.
• 4+ years of experience in claims processing, coding, auditing or health care operations.
• 4+ years experience in Payment Integrity.
• Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.

Nice To Haves

• 3+ years of experience working with large data sets using excel or a database language.
• Experience using SQL.

Responsibilities

• Provide subject matter expertise and in-depth understanding of Payment Integrity internal claims processing edits, external vendor edits and Oscar reimbursement policies.
• Lead Coordination of Benefits efforts within the payment integrity department.
• Respond to internal and external inquiries and disputes regarding COB policies and workflows.
• Document industry standard coding rules and provide recommendations on reimbursement policy language and scope.
• Ideate payment integrity opportunities based on a deep knowledge of industry standard coding rules and coordination of benefits.
• Provide training and education to team members when necessary.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Benefits

• 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.
• Participation in Oscar's unlimited vacation program.
• Annual performance bonuses.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree