Associate Director, Claims Compliance

This is a fully remote position, open to applicants in Texas.

📋 Description

• Oversee and coordinate various elements of Oscar's claims processes, which include research, adjustments, and regulatory inquiries.

• Lead a team of claims analysts focused on regulatory compliance, investigating inquiries and crafting external responses.

• Navigate sensitive, complex situations and develop departmental strategies utilizing industry insights along with quantitative and qualitative data.

• Convert the claims department's strategy into actionable business plans and tactics aimed at achieving operational KPIs, targets, and SLAs.

• Establish frameworks to fulfill programmatic and departmental objectives.

• Leverage business and industry expertise to guide strategy and implementation.

• Supervise and mentor managers and staff as required.

• Collaborate with other departments on claims matters, related initiatives, and inter-departmental operational issues.

• Manage processes and interdepartmental projects to guarantee timely outcomes or resolution of issues.

• Work with regulatory bodies and Oscar’s legal, audit, and compliance teams.

• Ensure adherence to all relevant laws and regulations.

• Carry out additional responsibilities as assigned.

• Report directly to the Senior Director, Claims Quality and Compliance.

⛳️ Requirements

• A minimum of 7 years of proven experience in claims operations and processing, insurance products, as well as regulatory and policy language.

• At least 5 years of experience in people management and team leadership, with the capability to prioritize, delegate tasks, and manage multiple high-value projects simultaneously.

• Established history of working with regulatory agencies and a strong understanding of regulatory requirements.

• Experience in generating data-driven, concrete solutions in environments characterized by imperfect information.

• Bachelor’s degree or 4 years of equivalent experience.

• Proficient in benefit and contract interpretation or coding in professional/institutional billing requirements.

• Experience in managing claims across various product types (e.g., Medicare or Commercial).

• Background in analyzing and enhancing processes and workflows.

• Familiarity with collaborating with technical teams (e.g., engineering and product) to articulate requirements, design tools, and assist with technical troubleshooting.

• Exceptional leadership and communication skills to facilitate decision-making and results across various partners.

🏝️ Benefits

• Employee benefits.

• 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 and disability insurance.

• Paid wellness time and reimbursements.