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

As the Vice President of Claims, this role is responsible for creating the vision and strategy for Oscar’s Claims and Benefit function. Responsible for building, configuring, scaling and optimizing processes related to benefit configuration, claims adjudication, provider payments, and regulatory compliance. You will be the function leader within our Operations team servicing our Oscar Health Insurance’s IFP, MA, and Small Group lines of business as well as our platform clients’ lines of business. You will also be responsible for managing and executing cross-functional processes related to business and operational readiness, and operational excellence. Your job is to design and build the machine so your teammates can drive efficiently and effectively.

You will report to the Chief Operating Officer.

This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

The base pay for this role is: $228,000 - $299,250. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants, and annual performance bonuses.

Responsibilities

Lead the organization that supports and builds scalable processes for benefit configuration, claims adjudication, and provider payments. Identify the most important and impactful processes and systematically map them and work to apply technology to automate and improve them while ensuring compliance, quality and cost effectiveness
Provide business requirements and cross functional support in the building, configuring, and improving Oscar’s technology platform(s) for adjudicating claims accurately and efficiently
Create management processes for identifying process / system / policy gaps and pain points, root causing issues, and architecting solutions to proactively ensure that our claims process operates at the highest level possible
Implement regulatory and business requirements into workflows and processes
Implement and monitor key controls
Find synergies between workflows and processes and work to eliminate redundancies
Work closely with leaders across the organization to ensure successful implementation and execution
Drive accountability throughout the claims organization; hire, develop, and motivate talent to drive success
Set up monitoring and metrics to consistently and accurately track outcomes
Participate in business development efforts with platform client prospects

Qualifications

10+ years experience in a claims role
5+ years of experience in healthcare operations with an emphasis on designing and reengineering healthcare operational processes
5+ years of experience in claims and benefits management
Strong experience in process / workflow building, operational improvement, and project management
Strong people management skills and team leadership
Experience in scaling an operation and executing in an environment undergoing rapid growth

Bonus Points

Experience or qualification in Lean methodology is preferable
Experience in onboarding/implementing B2B client business is preferable

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.

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