COB Verification Specialist

Oscar Health•Remote, AZ

13d•$18 - $24•Remote

About The Position

This role is responsible for managing end-to-end member data and payer eligibility to ensure accurate and timely claims processing. You will support issue resolution within the Oscar claims environment. You will report into the Manager, Payment Integrity. This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area.

Requirements

1+ years in health insurance claims, claims recovery, or a related field.
Proficient in basic google sheets and/or excel

Nice To Haves

Strong understanding of healthcare claims processing, medical billing, and insurance regulations (Medicare, Medicaid, commercial)
Familiarity with provider contract terms and payment methodologies
1+ years of related work experience in analytics or operations
Strong understanding of healthcare claims processing, medical billing, and insurance regulations (Medicare, Medicaid, commercial)

Responsibilities

Initiate the recovery process by conducting our reach to payers and providers on overpaid claims, and coordination with internal teams.
Make outbound calls to providers to explain overpayment findings and resolve disputes. Escalate internally for additional support with provider questions, as needed.
Maintain detailed records of all recovery activities, correspondence, and outcomes in Oscar's systems.
Support leadership to scope, size, prioritize items and deliver solutions
Compliance with all applicable laws and regulations
Other duties as assigned