Senior Analyst, Payment Integrity - Remote

Overview

The Senior Analyst, Payment Integrity role is responsible for supporting process improvement and issue resolution in the Oscar claim environment, leveraging a deep understanding of Oscar's claim infrastructure to identify actionable opportunities for improvement.

In Short

• Support process improvement and issue resolution in claims processing.
• Organize, scope, prepare, and execute solutions within claims edits.
• Collaborate cross-functionally to translate stakeholder friction into opportunities.
• Respond to internal and external inquiries regarding reimbursement policies.
• Research coding rules and provide input into reimbursement policy language.
• Identify thematic areas of opportunity to solve problems.
• Maintain transparency with stakeholders regarding progress and blockers.
• Provide root cause analysis and training for escalated issues.
• Comply with all applicable laws and regulations.
• Perform other duties as assigned.

Requirements

• Bachelor's degree or 4+ years of experience.
• 3+ years in claims processing, coding, or health care claims operations.
• 3+ years in medical coding within payment integrity.
• Medical coding certification (CPC, COC, CCS, RHIT, RHIA).
• Experience with reimbursement methodologies and claims processing practices.
• 2+ years deriving business insights from datasets.
• 1+ years improving business workflows and processes.
• 1+ years collaborating with stakeholders.

Benefits

• Eligibility for employee benefits.
• Participation in unlimited vacation program.
• Annual performance bonuses.
• Medical, dental, and vision benefits.
• 11 paid holidays and paid sick time.
• Paid parental leave.
• 401(k) plan participation.
• Life and disability insurance.
• Paid wellness time and reimbursements.