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 Vice President, Senior Claims Expert role is responsible for providing decision-making and advisory support to the Claims & Benefits team through extensive industry experience and subject matter expertise. They will be responsible for leading decision-making on critical initiatives and policies, and working through complex strategic and business claims issues, particularly where an industry lens is required. This individual will work cross-functionally with internal teams and engage in external discussions including with Regulators.

You will report to the Senior Vice President, Infrastructure Operations.

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, 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 is: $232,000 - $304,500 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities

Provide detailed guidance on Claims & Benefits topics (including implementation of regulations, system logic and configuration, payment methodologies, policies, etc.) based on industry standards and best practices.
Participate and present the claims industry point of view in internal and external discussions.
Drive decision-making process on key strategic initiatives and complex business issues.
Work closely with leaders within Claims & Benefits and across the organization on new policies and strategic initiatives.
Guide implementation of regulatory and business requirements into workflows and processes.
Guide implementation and monitoring of key controls.
Compliance with all applicable laws and regulations.
Other duties as assigned.

Qualifications

15+ years experience in a claims role
Extensive knowledge of and experience in implementing Claims regulations, payment methodologies and policies
5+ years of experience in healthcare operations with an emphasis on designing and reengineering healthcare operational processes
5+ years experience in process / workflow building, systems design / configuration, or operational improvement
5+ years people management

Bonus Points

Experience operating in an environment undergoing rapid growth

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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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