Remote opportunity at
OSCAR ASSOCIATES (AMERICAS), LLCAssociate, Payment Integrity
OSCAR ASSOCIATES (AMERICAS), LLC is hiring an Associate, Payment Integrity to join the Payment Integrity team. Operating as a health insurance company founded in 2012, the…
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About This Role
OSCAR ASSOCIATES (AMERICAS), LLC is hiring an Associate, Payment Integrity to join the Payment Integrity team. Operating as a health insurance company founded in 2012, the organization builds its operations around full-stack technology and member-focused care. In this role, the selected candidate will support issue resolution and process improvement throughout the claims environment for both Oscar Insurance and +Oscar clients. The position involves organizing, scoping, investigating, and implementing solutions related…
Job Description
OSCAR ASSOCIATES (AMERICAS), LLC is hiring an Associate, Payment Integrity to join the Payment Integrity team. Operating as a health insurance company founded in 2012, the organization builds its operations around full-stack technology and member-focused care. In this role, the selected candidate will support issue resolution and process improvement throughout the claims environment for both Oscar Insurance and +Oscar clients.
The position involves organizing, scoping, investigating, and implementing solutions related to edits and ideation. The professional will leverage knowledge of claim infrastructure, platform logic, and workflows to collaborate cross-culturally with stakeholders and translate friction points into actionable enhancements. Reporting to the Senior Manager, Payment Integrity, this remote position is available to individuals residing in Atlanta, Chicago, Dallas, Louisville, Minneapolis, Philadelphia, or Salt Lake City, with potential future models possibly involving hub office hybrid presence.
Responsibilities
- Deliver subject matter expertise regarding internal claims processing edits, external vendor edits, and reimbursement policies
- Address internal and external inquiries and disputes tied to edits and policies
- Formulate and document industry standard coding rules while recommending reimbursement policy scope and language
- Conceive payment integrity opportunities and translate them into business requirements for internal collaboration
- Review adverse claim outcomes with partners to scope, prioritize, and deliver solutions
- Analyze data mining and partner submissions to proactively locate thematic problem areas
- Communicate progress, status updates, and blockers transparently with stakeholders
- Conduct rapid research, root cause analysis, and training for escalated issues assigned by leadership
Requirements
- Possess a bachelor degree or four years of equivalent experience
- Accumulate at least four years of background in claims processing, healthcare operations, coding, or auditing
- Demonstrate four years of medical coding expertise inside payment integrity
- Have at least two years of experience drawing business insights from datasets and solving problems
- Display at least one year of experience enhancing business workflows and processes
- Contribute at least one year of experience collaborating with internal or external stakeholders
- Comply with applicable laws and regulations
Qualifications
- Hold a medical coding certification through AAPC (CPC, COC) or AHIMA (CSS, RHIT, RHIA)
- Bring two years of background in a technical capacity such as a PM, QA analyst, operations analyst, finance, consulting, or industrial engineering
- Have process improvement experience utilizing methodologies like Six Sigma
- Complete Process Improvement or Lean Six Sigma training
- Familiarity with SQL usage
Core Skills
Benefits
- Base pay remuneration between $82,717 and $108,566 per year
- Eligibility for annual performance bonuses
- Participation in an unlimited vacation program
- Medical, dental, and vision insurance coverage
- 11 paid holidays, paid sick time, and paid parental leave
- 401(k) plan enrollment
- Life and disability insurance coverage
- Paid wellness time and financial reimbursements
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position remote?
Yes, this is a remote position open to candidates residing in Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; or Salt Lake City, Utah. Future work models could potentially involve a hybrid presence at a local hub office.
What is the salary range for this role?
The base pay for this position ranges from $82,717 to $108,566 per year, determined by factors such as relevant skills, education, and experience.
What are the primary certification requirements?
Candidates must hold a medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA).
What benefits are provided to employees?
Full-time employees are eligible for medical, dental, and vision benefits, an unlimited vacation program, annual performance bonuses, 11 paid holidays, paid sick time, paid parental leave, 401(k) participation, life and disability insurance, and paid wellness time with reimbursements.
Sample Interview Questions
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