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About the Role
The Associate Director, Claims Compliance leads a team of analysts responsible for investigating and responding to regulatory inquiries, including market conduct exams. This role ensures adherence to state and federal regulations, works directly with regulators on exams and investigations, and partners across Insurance Operations and cross-functionally to strengthen claims compliance. The Associate Director transforms ideas into implementation to improve claims compliance and regulatory performance.
Responsibilities
- Direct and coordinate aspects of Oscar claims processes including research, adjustments, and regulatory inquiries.
- Lead a team of claims analysts specializing in regulatory compliance, tasked with investigating regulatory inquiries and developing external responses.
- Leverage industry background and knowledge of processes to influence others in sensitive complex situations while preserving relationships.
- Significantly influence departmental strategy by providing quantitative and qualitative inputs that drive organization success.
- Translate the claims department's strategy into business plans and tactics to meet operational KPIs, targets and SLAs.
- Create necessary structure to achieve programmatic and departmental goals.
- Understand and use business and industry knowledge to inform strategy and execution.
- Supervise and train managers and employees as needed.
- Collaborate and communicate with other departments on claims issues, related projects and inter-departmental operations issues while developing effective, actionable solutions.
- Effectively manage processes and inter departmental initiatives through a collaborative approach to ensure timely results or issue resolution.
- Work cross collaboratively with various regulatory agencies, as well as Oscar's legal, audit, and regulatory compliance teams.
- Ensure compliance with all applicable laws and regulations.
- Perform other duties as assigned.
Requirements
- 7+ years of demonstrated experience in claims operations and processing, insurance products, and regulatory and policy language.
- 5+ years of people management and team leadership experience with ability to prioritize, allocate work and manage across multiple high-value projects at once.
- Proven background collaborating with regulatory agencies and strong familiarity with regulatory requirements.
- Experience forming data-driven, concrete answers in a world with imperfect information.
- Bachelor's degree, or 4 years commensurate experience.
- Experience with benefit and contract interpretation or coding in professional/ institutional billing requirements.
- Experience managing claims across multiple product types ( i.e.Medicare or Commercial).
- Experience analyzing and improving processes and workflows.
- Experience working with technical teams (e.g. engineering and product) to communicate requirements, design tooling, and support technical troubleshooting.
- Excellent leadership and communication skills to drive decision-making and results across multiple partners.
Location
- New York City
Work Type
- Hybrid
Education Level
- Bachelor's degree
Salary/Compensations
- $149,040 - $195,615 per year
Benefits
- Employee benefits
- Oscar's unlimited vacation program
- Annual performance bonuses
- Medical benefits
- Dental benefits
- Vision benefits
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life insurance
- Disability insurance
- Paid wellness time and reimbursements
About the Company
- 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.
Equal 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.