COB Specialist, Payment Integrity

Hi, we're Oscar. We're hiring a COB Specialist to join our Payment Integrity team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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:

You will be responsible for supporting Coordination of Benefits (COB) efforts for Payment Integrity. This role is responsible for investigating and verifying proper payment of Oscar medical and pharmacy claims. You will create new COB workflows, enhance existing and drive COB audits.

You will report into the Manager, Payment Integrity.

Work Location:

This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Responsibilities:

• Contribute as a subject matter expert for Oscars COB reimbursement policies
• Respond to internal and external inquiries and disputes regarding COB policies
• Use knowledge gained through research and claims review to ideate COB 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 COB solutions.
• Use insights from partner submissions, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve COB 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.
• Analyze, investigate and confirm if dual coverage exists for Oscar membership
• Utilize data analysis skills and tools to develop accurate, quantitative analyses of payment issues
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 4+ years of commensurate experience
• 4+ years of experience in payment integrity, ideally coordination of benefits
• Experience with coordination of benefits 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
• Bonus points: 2+ years of experience working with large data sets using excel or a database language, preferably SQL.
• Experience with pharmacy coordination of benefits
• Experience in a professional healthcare claims organization
• Knowledge management, training, or content development in operational settings
• This is an authentic Oscar Health job opportunity.
• 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.

Artificial Intelligence (AI):

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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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