Claims Quality Analyst
3 weeks ago
Hi, we're Oscar. We're hiring a Claims Quality Analyst to join our Claims Quality 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 role**:
The Claims Quality Analyst role is responsible for end to end review of claims quality, communicating deficiencies to the business and obtaining mitigation for errors identified.
You will report to the Claims Quality Control Associate.
**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.
**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**:
- Reviewing medical claim reimbursements to ensure accuracy and compliance with relevant policies and regulations.
- Conducting audits of claim processing procedures and systems to identify internal control gaps
- Providing recommendations for process improvements and corrective actions to mitigate future errors.
- Documenting audit findings
- Participating in training sessions and workshops to enhance knowledge of relevant regulations and industry best practices.
- Monitoring and tracking audit findings and corrective actions to ensure timely resolution and compliance.
- Maintaining up-to-date knowledge of regulatory requirements and industry standards related to claim processing and reimbursement.
- Compliance with all applicable laws and regulations
- Other duties as assigned)
**Qualifications**:
- 2+ years of experience in claims auditing, configuration or provider appeals
- Experience utilizing CMS resources (i.e. referencing fee schedules and pricers)
- Identifying gaps and communicating them with cross functional stakeholders
**Bonus Points**:
- Experience working with provider contracts or claims configuration
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**:
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