COB Specialist, Payment Integrity

This is a fully remote position, open to applicants in Illinois, +5 more states.

📋 Description

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

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

• Develop new COB workflows and improve current ones.

• Lead COB audits.

• Report to the Manager of Payment Integrity.

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

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

• Investigate claims and convert COB opportunities into business requirements.

• Work in collaboration with internal teams to implement necessary changes.

• Gather information on adverse claim outcomes and assist in scoping, sizing, prioritizing, and delivering COB solutions.

• Identify overarching opportunities to address COB challenges.

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

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

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

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

• Perform additional duties as required.

⛳️ Requirements

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

• At least 4 years of experience in payment integrity, preferably in coordination of benefits.

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

• Minimum of 2 years of experience in deriving business insights from datasets and resolving issues.

• At least 1 year of experience in enhancing business workflows and processes.

• A minimum of 1 year of experience collaborating with internal and/or external stakeholders.

• Adherence to all applicable 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.

• Wellness reimbursements.