Associate Director – Claims Compliance

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

📋 Description

• Oversee and manage the various components of Oscar claims processes, encompassing research, adjustments, and regulatory inquiries.

• Lead a team of claims analysts in investigating regulatory inquiries and crafting external responses.

• Navigate sensitive and complex situations while providing both quantitative and qualitative insights to departmental strategy.

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

• Establish a framework to fulfill programmatic and departmental objectives.

• Utilize industry and business acumen to guide strategy and execution.

• Mentor and train managers and employees as required.

• Work collaboratively with various departments on claims-related issues, projects, and inter-departmental operational challenges.

• Oversee processes and interdepartmental initiatives to guarantee timely outcomes or resolution of issues.

• Engage with regulatory agencies alongside Oscar's legal, audit, and regulatory compliance teams.

• Ensure adherence to relevant laws and regulations.

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

⛳️ Requirements

• Over 7 years of proven experience in claims operations and processing, including insurance products and regulatory and policy language.

• More than 5 years of experience in people management and team leadership, with the capability to prioritize, allocate work, and manage multiple high-value projects simultaneously.

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

• Proven ability to develop data-driven, concrete solutions in environments with incomplete information.

• A bachelor's degree or 4 years of relevant experience.

• Familiarity with benefit and contract interpretation as well as coding in professional/institutional billing requirements.

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

• Background in analyzing and enhancing processes and workflows.

• Experience collaborating with technical teams to communicate requirements, design tools, and assist with technical troubleshooting.

• Exceptional leadership and communication skills to facilitate decision-making and drive results across multiple stakeholders.

🏝️ 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 insurance

• Disability insurance

• Paid wellness time

• Wellness reimbursements