Associate Director, Claims Operations

1 month ago

Tempe, Arizona, United States Oscar Health Full time
Job Summary

Oscar Health is seeking an experienced Associate Director, Claims Production to lead our claims team in managing open claim inventory, claim payment timeliness, and producing/managing/reporting on key performance indicators that drive the business and mitigate risk.

About the Role

In this critical leadership position, you will oversee cross-functional claims divisions, collaborate with business leaders and internal stakeholders to set strategy, and evaluate people-based business decisions. You will also direct and coordinate aspects of Oscar claims processes, including research, adjustments, and regulatory inquiries or escalations from providers.

Responsibilities
  • Manage open claim inventory and mitigate interest-bearing claims payments
  • Oversee cross-functional claims divisions, including production, adjustment, and disputes work units
  • Collaborate with business leaders and internal stakeholders to set strategy and evaluate people-based business decisions
  • Direct and coordinate aspects of Oscar claims processes, including research, adjustments, and regulatory inquiries or escalations from providers
  • Leverage industry background and knowledge of processes to influence others in complex situations
  • Translate the claims department's strategy into business plans and tactics to meet operational KPIs, targets, and SLAs
  • Create necessary structure to achieve programmatic and departmental goals
  • Understand and use business and industry knowledge to inform strategy and execution
  • Collaborate and communicate with other departments on claims issues, related projects, and inter-departmental operations issues
  • Effectively manage processes and inter-departmental initiatives through a collaborative approach to ensure timely results or issue resolution
  • Work cross-collaboratively with various regulatory agencies, as well as Oscar's legal, audit, and regulatory compliance teams
  • Responsible for ongoing career development of the team, maintaining culture, and employee satisfaction
  • Supervise and train managers and employees as needed
  • Compliance with all applicable laws and regulations
Qualifications
  • 7+ years of experience in claims operations, including adjudication, adjustments, and inventory management
  • 5+ years of people management and team leadership experience, with the ability to prioritize, allocate work, and manage across multiple high-value projects at once
  • 3+ years of experience with benefit and contract interpretation or coding in professional/institutional billing requirements
  • 3+ years of experience managing claims across multiple product types (i.e., Medicare or Commercial)
  • 3+ years of experience analyzing and improving processes and workflows
  • 5+ years of experience working with technical teams (e.g., engineering and product) in translating business requirement specifications
Bonus Points
  • Bachelor's degree or 4 years of commensurate experience
  • CPC or other professional coding certification
  • Experience in making data-driven decisions in a fast-paced environment
  • Excellent leadership and communication skills to drive decision-making and results across multiple partners

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