Claims Quality Senior Analyst

$72,800 - $95,550/Yr

Oscar Insurance Company - New York, NY

Full-time - Mid Level

Remote - New York, NY

Insurance Carriers and Related Activities

About the position

The Claims Quality Senior Analyst at Oscar is responsible for enhancing process improvement and resolving issues within the claims environment. This role involves organizing, scoping, triaging, investigating, and executing solutions related to claims, leveraging a comprehensive understanding of Oscar's claim infrastructure and workflows. The position emphasizes collaboration with internal and external partners to address adverse claim outcomes and improve overall claims processing efficiency.

Responsibilities

• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Utilize data analysis skills and tools to develop accurate, quantitative analyses of claims issues.
• Translate observations, findings and analysis results into business requirements; submit to and collaborate with internal partners to effectuate change.
• Work with the team to proactively identify thematic areas of opportunity to solve problems using insights from partner submissions, data mining, and process monitoring.
• Maintain transparency and collaboration by keeping stakeholders informed of progress, status changes, blockers, and completion; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
• Ensure compliance with all applicable laws and regulations.

Requirements

• 3+ years of experience in claims processing or auditing within healthcare operations.
• 2+ years experience improving business workflows and processes.
• 1+ years experience collaborating with internal and/or external stakeholders.

Nice-to-haves

• A bachelor's degree or 4+ years of commensurate experience.
• An academic and/or professional background in engineering, data, or healthcare.
• Experience in a professional healthcare claims organization.
• Knowledge management, training, or content development in operational settings.
• Process Improvement or Lean Six Sigma training.
• Experience using SQL.

Benefits

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