Hi, we're Oscar. We're hiring a Vice President, Claims to join our Operations team.

Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

As the Vice President of Claims, this role is responsible for creating the vision and strategy for Oscar’s Claims and Benefit function. Responsible for building, configuring, scaling and optimizing processes related to benefit configuration, claims adjudication, provider payments, and regulatory compliance. You will be the function leader within our Operations team servicing our Oscar Health Insurance’s IFP, MA, and Small Group lines of business as well as our platform clients’ lines of business. You will also be responsible for managing and executing cross-functional processes related to business and operational readiness, and operational excellence. Your job is to design and build the machine so your teammates can drive efficiently and effectively.

You will report to the Chief Operating Officer.

This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

The base pay for this role is: $228,000 - $299,250. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants, and annual performance bonuses.

Responsibilities

• Lead the organization that supports and builds scalable processes for benefit configuration, claims adjudication, and provider payments. Identify the most important and impactful processes and systematically map them and work to apply technology to automate and improve them while ensuring compliance, quality and cost effectiveness

• Provide business requirements and cross functional support in the building, configuring, and improving Oscar’s technology platform(s) for adjudicating claims accurately and efficiently

• Create management processes for identifying process / system / policy gaps and pain points, root causing issues, and architecting solutions to proactively ensure that our claims process operates at the highest level possible

• Implement regulatory and business requirements into workflows and processes

• Implement and monitor key controls

• Find synergies between workflows and processes and work to eliminate redundancies

• Work closely with leaders across the organization to ensure successful implementation and execution

• Drive accountability throughout the claims organization; hire, develop, and motivate talent to drive success

• Set up monitoring and metrics to consistently and accurately track outcomes

• Participate in business development efforts with platform client prospects

Qualifications

• 10+ years experience in a claims role

• 5+ years of experience in healthcare operations with an emphasis on designing and reengineering healthcare operational processes

• 5+ years of experience in claims and benefits management

• Strong experience in process / workflow building, operational improvement, and project management

• Strong people management skills and team leadership

• Experience in scaling an operation and executing in an environment undergoing rapid growth

Bonus Points

• Experience or qualification in Lean methodology is preferable

• Experience in onboarding/implementing B2B client business is preferable