Oscar Health

👥 1001-5000💰 $140,000,000 Private over 4 years ago🫂 Last layoff almost 5 years agoHealth Insurance InsurTech Insurance Health Care📈 Public Company

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Oscar Health is a health insurance company focused on providing innovative healthcare solutions and services. They are actively hiring for various roles including operational insights, regulatory affairs, data science, and software engineering to support their mission.

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Jobs at this company:

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🔥 Specialist, Payment Policy

Posted 11 days ago

📍 Alabama, Arizona, Arkansas, 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.

🧭 Full-Time

💸 59760.0 - 87150.0 USD per year

🔍 Health Insurance

🔧 Requirements

3+ years of experience in claims processing, coding, auditing or health care operations
3+ years experience in medical coding
Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
2+ years experience deriving business insights from datasets and solving problems
1+ years experience improving business workflows and processes
1+ years experience collaborating with internal and/or external stakeholders

💡 Responsibilities

Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.
Respond to internal and external inquiries and disputes regarding policies and edits.
Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
Compliance with all applicable laws and regulations
Other duties as assigned

SQLData AnalysisData MiningAPI testingREST APIData visualizationProcess improvement

Posted 11 days ago

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🔥 Specialist, Payment Integrity

Posted 11 days ago

🧭 Full-Time

💸 59760.0 - 87150.0 USD per year

🔍 Health Insurance

🔧 Requirements

3+ years of experience in claims processing, coding, auditing or health care operations
3+ years experience in medical coding
Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.
2+ years experience deriving business insights from datasets and solving problems
1+ years experience improving business workflows and processes
1+ years experience collaborating with internal and/or external stakeholders

💡 Responsibilities

Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.
Respond to internal and external inquiries and disputes regarding policies and edits.
Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
Compliance with all applicable laws and regulations
Other duties as assigned

SQLData AnalysisData MiningProcess improvement

Posted 11 days ago

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🔥 Senior Manager, Payment Integrity

Posted 11 days ago

🧭 Full-Time

💸 107280.0 - 156450.0 USD per year

🔍 Healthcare

🔧 Requirements

6+ years experience in operations, healthcare, data analytics and/or consulting
6+ years of experience analyzing data to solve complex business problems
3+ years of experience leading and developing a team
3+ years experience designing, implementing and improving business workflows
6+ years experience in medical coding
Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
Expert level experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.

💡 Responsibilities

Be the subject matter expert for Payment Integrity policies and claims processing edits through knowledge and expertise of Oscar’s claim platform, claim coding and regulatory requirements and operational workflows.
Anticipate, overcome, and prevent recurrence of complex problems and roadblocks in an efficient and effective manner
Create routines that drive cross-functional collaboration within and outside of department
Develop and implement standard Payment Integrity policies, procedures and workflows
Drive ideation of payment integrity opportunities
Manage inquiries related to Oscar edits & disputes
Monitor performance of Oscar edits, including but not limited to monthly quality audits.
Participate in governance committee activities to ensure alignment with internal stakeholders & business decisions.
Translate a strategic vision for the team and outline clear and measurable performance metrics / OKRs.
Coach, develop and lead a team to achieve identified outcomes.
Provide leadership in complex, cross-functional initiatives focused on claims improvement.
Manage a portfolio of initiatives and deliverables and proactively identify areas of opportunity to improve key performance indicators.
Compliance with all applicable laws and regulations
Other duties as assigned

LeadershipSQLData AnalysisPeople ManagementCross-functional Team LeadershipComplianceProcess improvementData analytics

Posted 11 days ago

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🔥 Senior Manager, Network Development

Posted 11 days ago

📍 Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Virginia, Washington, D.C.

🧭 Full-Time

💸 102240.0 - 149100.0 USD per year

🔍 Healthcare

🔧 Requirements

6+ years in healthcare recruiting or contracting, provider relations, or network management
3+ years experience in provider recruiting experience in healthcare, managed care, or insurance experience to drive growth and expansion in one or more geographical areas
3+ years of leadership experience

💡 Responsibilities

Implement provider recruiting strategies in partnership with Contracting and Market Leaders that align with the company’s overall network development and cost management objectives.
Manage and execute marketing, communication and outreach strategies to potential healthcare providers, focusing on brand messaging and value propositions while aligning with network adequacy needs.
Oversee a team of network recruiting analysts and associates providing direction, coaching, and performance management.
Implement recruitment and outreach policies and workflows; ensure effective and efficient recruiting and retention processes are in place.
Monitor and analyze key metrics for network recruitment, adequacy, and provider satisfaction, and provide reports to leadership.
Ensure timely responsiveness to provider questions and inquiries related to network participation, requirements and standards, contracting and provider services.
Build and maintain positive relationships with healthcare providers to ensure network stability and quality.
Compliance with all applicable laws and regulations.
Other duties as assigned .

LeadershipProject ManagementPeople ManagementHR ManagementCommunication SkillsAnalytical SkillsNegotiationComplianceReportingRecruitmentRelationship managementSales experienceMarket ResearchTeam managementStakeholder managementBudget management

Posted 11 days ago

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🔥 Senior Principal Engineer

Posted 18 days ago

🧭 Full-Time

💸 280800.0 - 368550.0 USD per year

🔍 Software Development

🔧 Requirements

15+ years experience in software engineering

💡 Responsibilities

Collaborate with business leaders to develop technical solutions for Oscar Health's most complex and high-impact challenges
Provide technical leadership and guidance to the Tech Leadership team, establishing technical vision, strategy, and goals aligned with Oscar’s overall business objectives.
Provide technical leadership and counsel to Oscar's Leadership Committee
Stay abreast of emerging technologies, industry trends, and best practices, evaluating their potential application and driving innovation within the software engineering and tech team broadly.
Teach, mentor, grow, and provide advice to other domain experts, and individual contributors, across the organization.
Provide a point of escalation for engineering teams facing complex technical challenges.
Define coding standards, development processes, and best practices to ensure high-quality software development across the Engineering team
Oversee system Integration of software components, systems, and third-party services, ensuring seamless interoperability and efficient data flow.
Evolve the software architecture and design principles, ensuring scalability, modularity, and flexibility to meet current and future needs
Partner with leadership to define productivity frameworks, identify and address scalability/performance challenges.
Other duties as assigned

AWSBackend DevelopmentLeadershipProject ManagementSoftware DevelopmentSQLCloud ComputingData AnalysisDesign PatternsFull Stack DevelopmentSoftware ArchitectureCross-functional Team LeadershipAlgorithmsData StructuresCommunication SkillsCI/CDProblem SolvingRESTful APIsMentoringMicroservicesStrategic thinkingNodeJSSoftware Engineering

Posted 18 days ago

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🔥 Compensation Manager

Posted 18 days ago

📍 Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, 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.

🧭 Full-Time

💸 102240.0 - 149100.0 USD per year

🔍 Health Insurance

🔧 Requirements

4+ of experience in compensation planning and analysis at a public company
Ability to lead programs and processes organization wide by 4+ years of demonstrated project management experience and the ability to handle multiple projects simultaneously while adhering to strict deadlines
4+ years of hands on experience in advanced excel with the ability to build complex models and create robust analyses
4+ years of expertise of job architecture and market data analysis
2+ years of Workday experience

💡 Responsibilities

Maintain and run the operations of compensation programs across Oscar, including broad based compensation planning, EOY review cycles, pay equity studies, sales compensation, and annual bonus plans.
Communicate and educate employees about the compensation philosophy and programs ensuring transparency and understanding while also ensuring other People Team members understand their role within the programs.
Act as the point of contact and project manager within the People Team to support compensation related initiatives.
Liaise with Finance teams to ensure accurate support of budgeting, headcount planning, and the bonus accruals process.
Conduct ongoing assessments of compensation plan performance/effectiveness and guide recommendations for enhancements and changes based on market best practices and Oscar’s current needs.
Support SOX compliance by providing support for applicable audits of process, calculations, and payment activity.
Compliance with all applicable laws and regulations
Other duties as assigned

Project ManagementData AnalysisSalesforceHR ManagementFinancial ManagementCommunication SkillsAnalytical SkillsMicrosoft ExcelComplianceMS OfficeNegotiation skillsBudgetingData visualizationFinancial analysis

Posted 18 days ago

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🔥 Associate, Strategic Planning and Enablement

Posted 22 days ago

🧭 Full-Time

💸 88560.0 - 129150.0 USD per year

🔍 Health Insurance

🔧 Requirements

3+ years of experience in strategy/ operations/ program management
2+ years of experience in leading end-to-end projects / programs, independently and within a team environment
Experience analyzing data and using metrics to drive improvements in programs

💡 Responsibilities

Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion.
Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies
Collaboratively works with all relevant internal and external stakeholder groups to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives
Mentor team members and promotes colleagues’ growth and professional development
Compliance with all applicable laws and regulations
Other duties as assigned

Project ManagementAgileData AnalysisProject CoordinationOperations ManagementCommunication SkillsAnalytical SkillsCross-functional collaborationRisk ManagementStakeholder managementStrategic thinkingChange Management

Posted 22 days ago

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🔥 NP/PA - Virtual Health Assessments (1099)

Posted 25 days ago

📍 Arizona, California, Colorado, Florida, Georgia, Illinois, Massachusetts, Michigan, Nevada, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, or Virginia

🧭 Contract

💸 70.0 - 75.0 USD per hour

🔍 Healthcare

🔧 Requirements

DNP, FNP, ENP, or PA from accredited program
Board Certification (NCCPA or AANP or ANCC)
Compact RN license (if an APRN)
3+ years of primary care experience
2+ years of experience delivering virtual care
Licensed in a minimum of 2 of the following states: GA, TX, FL, OH

💡 Responsibilities

Conduct virtual health assessment where the provider reviews the member's current medical diagnosis, medications and overall health history.
Review suspected conditions that can be utilized for Risk Adjustment for Oscar Health Insurance.
Identify and close HEDIS gaps, this will help the member stay up to date on appropriate preventative care.
Interacting with members virtually, including virtual assessment, diagnosis and treatment.

Posted 25 days ago

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🔥 1099 NP/PA, Virtual Urgent Care

Posted 25 days ago

📍 Arizona, California, Colorado, Florida, Georgia, Illinois, Massachusetts, Michigan, Nevada, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, or Virginia

🧭 Contract

💸 65.0 - 75.0 USD per hour

🔍 Healthcare

🔧 Requirements

DNP, FNP, ENP, or PA from accredited program
Board Certification (NCCPA or AANP or ANCC)
Compact RN license (if an APRN)
3+ years of urgent care experience
2+ years of experience delivering virtual care
Licensed in all three of these core Oscar States (FL, GA, TX)

💡 Responsibilities

Provide medical care virtually (both by phone and message)
Provide patient care in alignment with Oscar Medical Group guidelines, practices and policies
Focus on efficiency and quality of care delivery
Ensure patient access to VUC services
Collaborate with MAs, RNs, and other providers across service lines (e.g. primary care and health assessments)
Compliance with all applicable laws and regulations
Other duties as assigned

Data AnalysisREST APICommunication SkillsAnalytical SkillsCollaborationProblem SolvingCustomer serviceMicrosoft OfficeAgile methodologiesAttention to detailOrganizational skillsTime ManagementWritten communicationMultitaskingComplianceExcellent communication skillsAdaptabilityRelationship buildingEmpathyTroubleshootingActive listeningAbility to learnStrong communication skillsData entryRelationship managementQuality Assurance

Posted 25 days ago

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🔥 Manager, Formulary Operations

Posted about 1 month ago

🧭 Full-Time

💸 144000.0 - 189000.0 USD per year

🔍 Health Insurance

🔧 Requirements

Doctor of Pharmacy degree (PharmD)
3+ years working for PBM or Payer in clinical pharmacy operations
3+ years leading cross-functional teams/projects and change management
3+ years supporting formulary management (P&T Committee, clinical policy development, formulary run operations)

💡 Responsibilities

Ensuring clinical quality standards are met by maintaining clinical policies used for decision-making; ensure that compliance standards set by regulators and NCQA are defined in policies, that procedures are documented, and that those processes audited.
Operationalize, develop and maintain a clinically appropriate and cost-effective formulary and medical benefit preferred drug list
Provide written recommendations with responses and corresponding documentation for regulatory inquiries, feedback on future legislation, and other business questions that probe at formulary operations.
Responsible for annual formulary binder filings
Accountable and responsible for maintaining mental health parity NQTL responses and working cross-functionally for future filings and responding to ongoing objections during the audit process.
Compliance with all applicable laws and regulations
Other duties as assigned

Project ManagementHR ManagementCross-functional Team LeadershipBusiness OperationsAnalytical SkillsNegotiationWritten communicationComplianceRisk ManagementProcess improvementFinancial analysisData managementChange ManagementBudget management

Posted about 1 month ago

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