Associate, Payment Integrity Coordination of Benefits - Remote

Overview

The Associate, Payment Integrity is responsible for leading Coordination of Benefits efforts within the claims and Payment Integrity space, leveraging a deep understanding of Oscar's claim infrastructure and industry-standard knowledge to support overall payment integrity.

In Short

• Responsible for leading Coordination of Benefits efforts.
• Leverage understanding of claims infrastructure and workflows.
• Provide thought leadership for Payment Integrity processes.
• Identify overpayments and prevent inaccurate claim adjudication.
• Respond to inquiries regarding COB policies and workflows.
• Document coding rules and provide policy recommendations.
• Provide training and education to team members.
• Support research and root cause analysis for escalated issues.
• Ensure compliance with applicable laws and regulations.
• Other duties as assigned.

Requirements

• Bachelor's degree or 4+ years of relevant experience.
• 4+ years of experience in claims processing or health care operations.
• 4+ years of experience in Payment Integrity.
• Experience with reimbursement methodologies and claims processing.

Benefits

• Eligible for employee benefits including medical, dental, and vision.
• Participation in unlimited vacation program.
• Annual performance bonuses.
• Paid holidays and sick time.
• 401(k) plan participation.
• Life and disability insurance.
• Paid wellness time and reimbursements.