Senior Operations Manager, Claims Configuration

Job Description

Hi, we're Oscar. We're hiring a Senior Manager to join our Insurance 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 Senior Manager, claims configuration, you will develop strategies that support consistency, efficiency and overall integrity of benefits administration at Oscar. To accomplish this, you will design standardized tools, templates, workflows, service level agreements, and quality controls to improve implementation and ongoing management of plans and benefits across a diverse range of clients, markets, and health insurance products. Working with all partners to determine plan design and benefit configuration requirements, manage project schedules, manage risks, guide benefit configuration priorities, and coordinate implementation activities.

In partnership with teams across Operations, Market P&L and technology teams, you will build scalable benefit configuration workflows and technical solutions to benefit administration challenges.

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

Responsibilities:

• Develop standardized tools and workflows for collecting, documenting, and tracking plan build and benefit configuration requirements.
• Design, organize and lead process improvement efforts throughout the benefit design and implementation lifecycle.
• Support resource planning and project scoping activities necessary to implement new platform capabilities and clients. Develop proposals outlining proposed project approach and work plan.
• In partnership with Oscar's Plan Design, Insurance Operations, and tech teams, develop and document standard service level agreements/goals for plan build and benefit configuration activities.
• Ensure that overall benefit operations, and project-specific, performance metrics are in place and are managed.
• Coordinate plan build and benefit configuration activities across projects, managing interdependencies and ensuring appropriate resource allocation.
• Establish quality assurance/testing strategies and help develop test plans.
• Support roadmap-planning process, partnering with the Director, Benefits Configuration to determine short-term and long-term program goals.
• Develop Configuration Analysts team to ensure program goals are met.

Requirements:

• 6+ years of managing, driving and overseeing large projects or implementing process improvements within a managed care/insurance organization.
• 4+ years of leadership experience
• Lean Six Sigma Yellow Belt or comparable certification. If you do not have the required certification, then certification must be obtained within twelve months of employment.
• Successful past application of Lean/Continuous Process Improvement concepts.
• Experience managing teams and complex projects.
• Experience facilitating/leading requirements gathering processes.

Bonus points:

• A technical bend and the ability to use tools to answer your own questions (e.g., SQL/Python)
• Lean Six Sigma Green Belt or Black Belt certification.
• Experience in managed care operations health insurance benefit configuration, claim adjudication, or similar experience.
• Experience designing test plans.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here .

Life at Oscar:

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

We aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

Reasonable Accommodation:

Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([email protected]) to make the need for an accommodation known.

To protect the health and safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at [email protected] to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices, employees conducting sales work in the field and employees conducting at-home or in-person visits with members.