Associate, Payment Integrity Data Mining

About Oscar Health

Hi, we're Oscar. We're hiring an Associate, Payment Integrity Data Mining 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.

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.

About The Role

The Associate, Payment Integrity Data Mining ensures payment integrity data mining programs are running smoothly and effectively. The Associate is a subject matter expert for the team and a key stakeholder in facilitating vendor and internal payment integrity programs. The Associate, Payment Integrity Data Mining provides thought leadership for processes and workflows that impact payment integrity and improve data mining solutions.

You will report into the Senior Manager, Payment Integrity.

Responsibilities

• Provide subject matter expertise and in-depth understanding of data mining workflows and program rules.
• Identify payment integrity solution issues that require action and provide steps needed to remediate the issue.
• Identify claims with post-payment errors and facilitate processes to recover payments and ensure future payment accuracy.
• Represent data mining payment integrity solutions in payment policy discussions and when necessary, document new policies or modifications to existing policies.
• Provide training and education to team members when necessary.
• Serve as a subject matter expert using internal and external tools in order to complete audits and provide guidance to team members.
• Serve as an in-house expert on data structure and visualization for various stakeholders in service operations.
• Facilitate quality review and validation of data mining concepts and overpayment identifications.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Requirements

• 3+ years of experience in claims processing, auditing or health care operations.
• 3+ years of experience in building or supporting data mining payment integrity solutions.
• Proven ability to work independently to drive projects to completion.
• Some coding experience or database language exposure.

Bonus Points

• Bachelor’s degree.
• 3+ years of related work experience in analytics or operations.
• Experience with claims pricing algorithms and/or software.
• Experience using SQL.

Key skills/competency

• Data Mining
• Payment Integrity
• Claims Processing
• Healthcare Operations
• Auditing
• SQL
• Data Visualization
• Compliance
• Problem Solving
• Workflow Optimization