Manager – Complex Claims
| Company | Oscar Health |
|---|---|
| Location | Los Angeles, CA, USA, Tempe, AZ, USA, New York, NY, USA |
| Salary | $79920 – $116550 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Senior |
Requirements
- Bachelor’s degree or 4 years of commensurate experience
- 4+ years of experience leading, coaching and developing direct reports in a healthcare claims production environment
- 3+ years of experience with using data and metrics to problem solve and drive root cause analysis
Responsibilities
- Adjudicate highly complex claims with technical complexity and coordination ensuring claims are processed timely and accurately
- Lead teams for the review of highly specialized claims processing including: high cost claims, transplants, COB and other third-party insurance
- Conducting detailed information gathering, analysis and investigation to find solutions, and reporting to senior leaders on complex claims trends and developments
- Conduct file reviews to ensure accuracy
- Ensure team meets daily, monthly and annual production goals and performance objectives for both quality and productivity
- Creating, tracking, and implementing best practices for Production Management to improve overall member experience through daily queue management and production tracking.
- Utilize frameworks to intentionally develop and coach your team in order to build future leaders within the organization
- Take a proactive, forward-thinking and data-driven approach to identify concerns, inefficiencies, and operational improvement initiatives throughout the Claims space that drive desired cultural and operational outcomes
- Compliance with all applicable laws and regulations
- Other duties as assigned
Preferred Qualifications
- Proficiency in Microsoft Office Suite
- Process Improvement or Lean Six Sigma training, certification
- Experience as a leader in a remote environment
- Experience in BPO or Call Center environments