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Claims Recovery Specialist
3 months ago
Hi, we're Oscar. We're hiring a Claims Recovery Specialist to join our Payment Integrity team.
Oscar is the first health insurance company built around a full stack technology platform and a 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 roleThe Claims Recovery Specialist is responsible for the provider notification, communication and recovery of overpaid claims. You will send notification to providers of the overpayments, follow up with providers via various available communication channels and recover the identified overpayments. You will maintain accurate records of claim status, correspondence, and resolution efforts using designated systems.
You will report to the Senior Manager, Recovery Services.
Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.
If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.
You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote
Pay Transparency:
The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $27.31 - $35.84 per hour. The base pay for this role in all other locations is: $24.58 - $32.26 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 10 days per year.
Responsibilities- Analyze, investigate claims date to determine the root cause of an identified overpayment
- Communicate effectively with healthcare providers to recover identified overpayment
- Prepare and submit notification letters, supporting documentation, and any necessary forms to pursue maximum reimbursement
- Maintain accurate records of claim status, correspondence, and resolution efforts using designated software systems
- Stay informed about changes in health insurance regulations, coding guidelines, and reimbursement policies to ensure compliance and optimize claim recovery strategies
- Compliance with all applicable laws and regulations
- Other duties as assigned
- 2+ years of experience in claims processing, auditing or health care operations
- 2+ years experience recovery and/or billing experience
- 2+ years of experience working with large data sets using excel or similar
- 2+ years of related work experience in analytics or operations
- Customer service and/or provider communication experience
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Notice to Job Applicants.
