COB Specialist, Payment Integrity

This is a fully remote position, open to applicants in Arizona, +7 more locations.

📋 Description

• Assist in the Coordination of Benefits (COB) initiatives for Payment Integrity.

• Examine and confirm the appropriate payment of Oscar's medical and pharmacy claims.

• Develop new COB workflows, enhance current workflows, and lead COB audits.

• Act as a subject matter expert on Oscar's COB reimbursement policies.

• Address internal and external inquiries and disputes related to COB policies.

• Investigate claims and recognize COB opportunities; convert findings into business requirements.

• Work alongside internal and external partners to define, prioritize, and implement COB solutions.

• Identify overarching opportunities to resolve COB challenges.

• Keep stakeholders updated on progress, status changes, obstacles, and completions.

• Provide research, root cause analysis, and training for escalated issues.

• Analyze, investigate, and validate the existence of dual coverage for Oscar members.

• Utilize data analysis skills and tools to create quantitative analyses of payment issues.

• Report directly to the Manager of Payment Integrity.

⛳️ Requirements

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

• 4+ years of experience in payment integrity, particularly in coordination of benefits.

• Familiarity with coordination of benefits reimbursement methodologies, provider contract concepts, and common claims processing/resolution practices.

• 2+ years of experience in deriving business insights from datasets and addressing problems.

• 1+ years of experience in enhancing business workflows and processes.

• 1+ years of experience in collaborating with internal and/or external stakeholders.

• Adherence to all relevant laws and regulations.

🏝️ 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 and reimbursements.