Associate, Payment Integrity (Data Mining)

Hi, we're Oscar. We're hiring an Associate, 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.

About The Role

The Associate, 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, 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

Work Location

This position is based in our Tempe, Arizona office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule.

Pay Transparency

The base pay for this role is: $87,188 - $114,434 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

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

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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.

Artificial Intelligence (ai)

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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.

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