Associate, Regulatory Affairs
About The Position
The Associate, Regulatory Affairs, is a major contributor and owner of mission-critical workflows to manage the Independent Dispute Resolution process. In assigned jurisdictions, you will intake disputes from providers, engage in negotiation with business unit support, perform all relevant admin functions, and ultimately prepare arbitration briefing where needed, all while creating and maintaining detailed documentation for tracking purposes. You will work with Regulatory Counsel to update workflows, keep tabs on developments to No Surprises Act policies, and support the Regulatory Affairs function by serving as an enterprise wide resource on IDR trends. You will report into the Director, Regulatory Affairs.
Requirements
- Bachelor's degree in the humanities, legal studies, political science, public policy, public administration, public health or other relevant field, or a combination of education and experience.
- 3+ years of legal or regulatory experience, ideally in the health plan/managed care space.
- 2+ years experience working with state and federal political and legislative processes.
- 2+ years experience, legislative tracking software, and Google Workspace.
- 2+ years experience with insurance claims, appeals or regulatory complaints.
Nice To Haves
- Experience working with Independent Dispute Resolution is a huge plus
- Experience working in personal injury law firms or as a paralegal
- Familiarity with the Affordable Care Act and the No Surprises Act
- Experience with Oscar markets.
- Experience working with attorneys and internal stakeholders.
Responsibilities
- Be the subject matter expert on assigned state and federal policy for provider dispute and IDR matters, while applying newly proposed laws and regulations to processes in assigned jurisdictions.
- Prepare concise, user-friendly briefing based on case needs.
- Be the team resource through mentoring team members, maintaining workflows, and work cross functionally to implement solutions where needed.
- Partner with PRO Counsel, Regulatory Affairs colleagues, and cross functional business partners to problem solve and stand up new processes.
- Support + optimize sustainable processes which simplify our growing team's outputs while ensuring high quality deliverables.
- Manage projects with notable complexity with business area implications, developing action plans and managing from start to completion.
- Deliver multiple, simultaneous and diverse assignments while adhering to strict deadlines.
- Support cross-training, and knowledge development across Oscar
- Perform eligibility reviews of disputed claims to ensure all cases are routed to the appropriate venue
- Manage the end-to-end administrative lifecycle of each dispute by maintaining real-time updates on project management boards, gathering and redacting member documentation, and uploading supporting evidence to the appropriate portal stages within set regulatory deadlines
- Independently manage workload and related dependencies in compliance with required regulatory timelines
- 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
