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Associate, Member

2 months ago

New York, New York, United States Oscar Health Full time
About the Role

The Associate, Member & Provider Compliance Specialist will play a crucial tactical role in supporting compliance within Member and Provider Operations by analyzing challenges, coordinating responses, and delivering positive outcomes based on inputs from stakeholders.

Key Responsibilities
  • Collaborate with team members and senior leaders to address process gaps and improvements.
  • Perform data pulls and conduct detailed analysis to support compliance initiatives.
  • Develop trusting relationships with internal and external stakeholders through effective communication and collaboration.
  • Draft detailed narratives and reports to communicate compliance findings and updates, including responses to Regulator/NCQA requests and examinations.
  • Oversee the Policies & Procedures review process within Operations, ensuring that all policies and procedures are up-to-date and meet internal requirements as outlined by Compliance team.
  • Support Oscar team members through knowledge sharing, process documentation, and tooling development.
  • Assist in preparing for Market Conduct Exams and other regulatory reviews.
  • Stay informed on business requirements and act on regulatory updates guided by Oscar's Compliance team to ensure adherence to effective processes and procedures.
Requirements
  • Demonstrated understanding of Member (including Appeals & Grievances) & Provider operations in the health payer industry.
  • 3+ years of relevant experience working with operational compliance, regulatory, and data analysis within the healthcare industry.
  • 3+ years experience working with regulatory bodies and Market Conduct Exams.
  • 3+ years experience designing and improving workflows.
Bonus Points
  • Experience managing complicated business challenges: developing understanding, distilling and communicating that understanding to technical and non-technical audiences.
  • An academic and professional background in engineering, data, or healthcare.
  • Knowledge management, training, or content development in operational settings.
  • Process Improvement or Lean Six Sigma certification.
  • Structured, systematic, and critical thinking.
  • Strong verbal and written communications.
  • 3+ years experience using data software (e.g. Excel, VGA, Macros, SQL and/or Python) to manipulate and analyze large data sets to solve business problems.