Manager, Complex Claims

Hi, we're Oscar. We're hiring a Manager, Complex Claims to join our Claims Production team.

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.

The Manager, Complex Claims leads a team tasked with tactical and strategic initiatives with the goal of improving complex claim outcomes across a series of key performance metrics. The Manager plays a critical role in the overall claims improvement apparatus by providing leadership, structure and organization, enabling the team to succeed.

You will report to the Associate Director, Claims Production.

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, 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. 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 - $129,000 per year. The base pay for this role in all other locations is: $92,880 - $116,100 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

• Be the subject matter expert for Claims operations through knowledge and expertise of Oscar’s claim platform, claim regulatory requirements and operational workflows
• Manage a complex portfolio of initiatives and deliverables and proactively identify areas of opportunity to improve key performance indicators
• Develop team workflows and guidelines that produce consistent and measurable outcomes; train, teach and mentor team members to become more proficient and effective.
• Lead teams for the review of highly specialized claims processing including: high cost claims, transplants, COB and other third-party insurance 
• Conducting detailed information gathering, analysis and investigation to find solutions, and reporting to senior leaders on complex claims trends and developments
• Compliance with all applicable laws and regulations
• Other duties as assigned

• A bachelor’s degree or 4+ years of commensurate experience
• 4+ years leading, coaching and developing direct reports in a claims environment 
• 4+ years of experience analyzing data to solve complex claims problems
• 2+ years experience designing, implementing and improving business workflows

• Process Improvement or Lean Six Sigma training, certification
• Experience developing project plans in collaboration with internal and external stakeholders
• Experience with healthcare claims processing