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Compliance Associate

2 months ago

Tempe, Arizona, United States Oscar Health Full time
About the Role

Oscar Health is seeking a highly skilled Compliance Associate to join our Insurance Operations team. As a key member of our team, you will play a crucial role in supporting compliance within Member and Provider Operations by analyzing challenges, coordinating responses, and delivering positive outcomes based on inputs from stakeholders.

The ideal candidate will have a strong understanding of Member (including Appeals & Grievances) & Provider operations in the health payer industry, with 3+ years of relevant experience working with operational compliance, regulatory, and data analysis within the healthcare industry.

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.
Qualifications
  • 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.
What We Offer

Oscar Health is committed to providing a comprehensive benefits package, 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.

We are an Equal Opportunity Employer and welcome applications from diverse candidates. If you require reasonable accommodations during the application process, please contact the Oscar Benefits Team.