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 Senior Manager, Claims Reporting, you will be responsible for developing and overseeing the efficient and accurate reporting and monitoring of claims data. Specifically, you will be responsible for connecting the dots between activities that drive claims payment and trends in paid claims, in order to support accurate prediction of claims payments and ensure appropriate monitoring is in place. In addition, you will be responsible for evaluating and addressing claims reporting needs from Claims leadership and other key stakeholders. Critical to your success will be partnering cross-functionally with Actuarial, Finance, Business Analytics, Data Science and Claims management.

You will report to the Senior Director, Claims Quality.

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 Ave), 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.

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Kentucky, 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

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $119,200 - $156,450 per year. The base pay for this role in all other locations is: $107,280 - $140,805 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

Identify, monitor and report timely on factors that cause variability in claims payment (such as claims volume, denial rates, payment integrity activities, changes in inventory and other driving factors).
Provide daily monitoring of claims payment factors, surfacing unexpected data points and tracking down the explanation behind such data points.
Proactively raise issues and influence the thinking of the Claims team and other key stakeholders on the potential impact and resolution of such underlying issues.
Partner closely with Finance and Actuarial to develop a strong working model; connect the dots between claims payment factors monitored and daily paid claims data, enabling Actuarial to better predict claims spend.
Ensure effective monitoring and oversight of claims activities that drive claims payment; recommend and develop additional controls where needed.
Partner with and provide claims expertise to our Data Science team on projects to design, develop and deep dive on claims performance metrics.
Represent Claims in monthly close activities with Actuarial and Finance to ensure a common understanding of claims activity and inventory.
Develop dashboards and reporting to support proactive management of our strategic provider partners from a claims perspective.
Evaluate business needs and develop dashboards and reporting that improve our ability to monitor claims activity and manage and improve claims performance.
Compliance with all applicable laws and regulations
Other duties as assigned

Qualifications

6+ years of data, analytics or reporting experience
3+ years of experience working with healthcare claims data
Strong working knowledge of health plan claims department operations, key performance metrics, processes and information flow
Familiarity with Actuary and Finance work regarding claims payments and estimating claims trends and experience working with such teams
Analytic and technical ability to develop dashboards and reports
Strong written and verbal communication skills

Bonus Points

Proficiency in Looker and Periscope

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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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