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

The Complex Issue Resolution Program Manager is responsible for leading all activities related to program implementation goals to ensure success. Additionally, identifying and driving operational improvements for claims quality operations, including proper controls and monitoring, to ensure operational efficiency and effectiveness, overseeing and coordinating claims issue resolution projects across the organization.

You will report to the Associate 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 Dr), 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, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, 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: $103,200 - $135,450 per year. The base pay for this role in all other locations is: $92,880 - $121,905 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

Organize and lead daily activities for claims issue resolution programs
Identify, develop and implement program strategy, optimizations and tooling that support the organization’s objectives.
Meet with stakeholders to discuss program status and goals
Oversee implementations end to end to ensure program success
Partner with other departments and various stakeholders to ensure operational excellence
Analyze program risks; ability to anticipate risks and issues. This includes proactive flagging of issues, managing escalations, and tracking and helping to resolve risks and issues.
Ensure proper controls and monitoring are in place for the program
Work with leadership and the program stakeholders to lead program retros and assess program strengths and weaknesses
Ensure proper metrics are in place to measure program success
Compliance with all applicable laws and regulations
Other duties as assigned

Qualifications

4+ years of program and project management
4+ years experience in change management and process improvement
Healthcare claims experience

Bonus Points

PMP or Six Sigma certification
Experience leading teams within claims

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.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.

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