Oscar Health

Provide technical support and troubleshoot complex enterprise IT issues across multiple platforms. | Experience in technical support, troubleshooting, and escalation management in IT environments. | Hi, we're Oscar. We're hiring a Senior Specialist, Coding Auditor to join our Payment Integrity. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: You will support issue resolution in the Oscar claim environment. You will be responsible for the end-to-end claims repayment quality, process improvement and supporting root cause analysis. You will report into the VP, Payment Integrity. Work Location: This is a remote position, open to candidates who reside in: Tempe, Arizona; Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; New York City, New York; Philadelphia, Pennsylvania; Salt Lake City, Utah. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role in New York City is: $65,412 - $85,853 per year. The base pay for this role in all other locations is: $58,870 - $77,267 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses. Responsibilities: Develop and maintain a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements. Efficiently perform thorough and complex policy updates or audits of assigned documentation (i.e. medical records or claims) on both a prepayment and/or post payment basis to determine accuracy of claims submitted to Oscar. Explicitly document findings including reference to sources used to support decision making and in a way that can be easily understood by non clinicians or coders. Create reports and reference guides that can be used by other team members to communicate findings or more effectively perform similar reviews. Assist in drafting written communications to providers to convey findings. Participate in educational calls with providers. Assist in the training of new team members. Develop and document processes to improve the efficiency and effectiveness of the team. Compliance with all applicable laws and regulations Other duties as assigned Requirements: 1+ years of coding or auditing experience across multiple specialties. Certified Professional Coder (CPC) designation or similar certification Bachelor's degree or 4+ years of work experience Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting. Bonus points: Certified Professional Medical Auditor Payment Integrity audit experience Demonstrated experience translating technical jargon to non-technical end users. Experience with HIPAA, data privacy, and/or data security processes Experience working with regulators governing (public or private) health insurance carriers This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 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. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. 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 (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

Leading complex, strategic AI-related product initiatives, collaborating across teams, and influencing product practices. | 7+ years of product management experience, with at least 1 year in AI or healthcare, experience building new products, and strong data skills. | Hi, we're Oscar. We're hiring a Staff Product Manager to join our AI team. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: The Staff Product Manager is a senior individual contributor role responsible for defining and driving complex, technical product initiatives with strategic impact across the organization. In this role, you will identify and solve the most valuable business problems through deep user empathy, sharp product intuition, and a strong understanding of Oscar’s operating model and business levers. You will partner closely with engineering, data, and design to lead complex initiatives across domains, aligning directly with senior business leaders on priorities and outcomes. You will act as a force multiplier within the organization—mentoring peers, influencing product practices, and consistently raising the bar on quality, clarity, and impact. In this Staff Product Manager role, you will focus on AI research and development. You’ll work closely with a small team of engineers and data scientists to explore and prototype new concepts and workflows across Oscar. You will report into the Senior Director, AI. Work Location: This is a remote position, open to candidates who reside in: Boston, MA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote Pay Transparency: The base pay for this role is: $180,504.00 - $236,911.50 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants and annual performance bonuses. Responsibilities: Helping to define the vision, strategy and roadmap for tech components, workflows, and insights that make it easy for teams across Oscar to leverage AI. Partnering closely with stakeholders including cross functional department leaders across the business to define strategy and roadmap. Collaborating with Engineering and Product leadership to make resource trade-off decisions and to ensure teams are working together effectively. Provide recommendations to leadership for product enhancements to improve existing products and development of new ones. Develop operating models for new products in partnership with leadership. Compliance with all applicable laws and regulations. Other duties as assigned. Requirements: 7+ years of Product Management experience. 1+ years of Product Management experience in an AI or healthcare setting. Experience building a net new product 0-1. Bonus points Experience developing AI or ML-related features strongly preferred. Experience building AI infrastructure. SQL skills strongly preferred. Comfort in working in highly collaborative environments while ensuring the team is always driving towards a decision. Excellent analytical and quantitative skills; proved experience using data to identify opportunities, test theories and evaluate success. Experience as an end-to-end thinker; the ability to look at a problem and create a solution all the way from top-level goals to smaller details. Ability to influence and manage stakeholders at all levels and experience working across all levels of leadership using strong communication and structured thinking. This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 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. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. 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 (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

Manage and optimize health insurance programs, ensuring compliance, scalability, and effective cross-functional execution. | Requires 4+ years in program management, 3+ years delivering projects, and experience with prior authorization processes, ideally in healthcare or insurance. | Hi, we're Oscar. We're hiring a UM Program Operations Manager to join our UM Strategy team. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: The Manager of UM Program Operations is the "Execution Engine" of the UM Strategy team. While our strategists identify what we should do, you own the how. You are responsible for the flawless execution of high-impact programs like Gold Carding, Provider Incentive Programs, and the maintenance of our Prior Authorization (PA) List. You will ensure that every program is operationally sound, regulatory compliant, and scales effectively as our footprint expands. You will report into the Director, UM Authorization Strategy. Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote Pay Transparency: The base pay for this role is: $105,808 - $138,886 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses. Responsibilities: Lead the end-to-end execution and refresh cycles for "Gold Card" and "Provider Incentive" programs. This includes managing provider entry/exit criteria, coordinating the clinical audit framework, and ensuring accurate provider status updates. Act as the primary owner of the "Source of Truth" for the Prior Authorization list. You will lead the cross-functional governance process to ensure code additions, removals, and modifications are clinically adherent and accurately reflected across all internal systems and public-facing documents. Ensure all UM programs meet state and federal mandates, including emerging "Gold Card" legislation and transparency requirements. You will be the team's point of contact for Legal and Compliance audits. Develop and maintain the Standard Operating Procedures (SOPs) for net-new initiatives. You ensure that as the team innovates, the operational "blueprints" exist to make those innovations repeatable. Drive the recurring refresh cycles for auto-approval rules and provider incentive programs, ensuring they remain current with shifting clinical guidelines and medical policies. Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion. Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies. Collaboratively works with all relevant internal and external stakeholder groups to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives May oversee team members directly as well as mentors team members and promotes colleagues' growth and professional development Compliance with all applicable laws and regulations Other duties as assigned Requirements: 4+ years of experience in program management 3+ years of experience in delivering projects / programs 2+ years of experience in managing prior authorization list process (updates, coordination) Experience in payer/health insurance Bonus points: Experience using data and metrics to drive improvements in programs Experience / background in a fast-paced operations environment Experience managing Gold Card programs and updates Experience managing the Prior Authorization List process Successfully executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support Master's Degree PMP Certifications or Program Management Certifications Lean/Six Sigma Certifications Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting) This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 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. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. 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 (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

Manage and optimize healthcare program operations, ensuring compliance, scalability, and stakeholder engagement. | Requires 4+ years in program management, healthcare experience, and managing prior authorization processes, which are not present in your aerospace-focused background. | Hi, we're Oscar. We're hiring a UM Program Operations Manager to join our UM Strategy team. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: The Manager of UM Program Operations is the "Execution Engine" of the UM Strategy team. While our strategists identify what we should do, you own the how. You are responsible for the flawless execution of high-impact programs like Gold Carding, Provider Incentive Programs, and the maintenance of our Prior Authorization (PA) List. You will ensure that every program is operationally sound, regulatory compliant, and scales effectively as our footprint expands. You will report into the Director, UM Authorization Strategy. Work Location: This position is based in our Tempe, Arizona office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid Pay Transparency: The base pay for this role is: $105,808 - $138,886 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses. Responsibilities: Lead the end-to-end execution and refresh cycles for "Gold Card" and "Provider Incentive" programs. This includes managing provider entry/exit criteria, coordinating the clinical audit framework, and ensuring accurate provider status updates. Act as the primary owner of the "Source of Truth" for the Prior Authorization list. You will lead the cross-functional governance process to ensure code additions, removals, and modifications are clinically adherent and accurately reflected across all internal systems and public-facing documents. Ensure all UM programs meet state and federal mandates, including emerging "Gold Card" legislation and transparency requirements. You will be the team's point of contact for Legal and Compliance audits. Develop and maintain the Standard Operating Procedures (SOPs) for net-new initiatives. You ensure that as the team innovates, the operational "blueprints" exist to make those innovations repeatable. Drive the recurring refresh cycles for auto-approval rules and provider incentive programs, ensuring they remain current with shifting clinical guidelines and medical policies. Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion. Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies. Collaboratively works with all relevant internal and external stakeholder groups to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives May oversee team members directly as well as mentors team members and promotes colleagues' growth and professional development Compliance with all applicable laws and regulations Other duties as assigned Requirements: 4+ years of experience in program management 3+ years of experience in delivering projects / programs 2+ years of experience in managing prior authorization list process (updates, coordination) Experience in payer/health insurance Bonus points: Experience using data and metrics to drive improvements in programs Experience / background in a fast-paced operations environment Experience managing Gold Card programs and updates Experience managing the Prior Authorization List process Successfully executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support Master's Degree PMP Certifications or Program Management Certifications Lean/Six Sigma Certifications Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting) This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 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. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. 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 (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

Lead analytics projects to identify cost-saving opportunities and measure clinical outcomes, mentoring team members and collaborating with stakeholders. | Requires 7+ years of quantitative analysis experience, healthcare or insurance industry knowledge, and a STEM degree; your logistics background does not meet these core requirements. | Hi, we're Oscar. We're hiring a Senior Manager, Medical Economics to join our Medical Economics team. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: The Senior Manager, Medical Economics, leads a team of analysts to drive actions to support Oscar's total cost of care (TCoC) strategy and efforts. The Senior Manager collaborates closely with analytical leads across forecasting, medical cost analytics, pricing, network analytics, and data science units to identify medical expense saving opportunities and to develop sound projections and measurements of the medical cost effects and clinical outcomes of initiatives, with an ultimate goal of improving total cost of care and driving affordability value. You will report into the VP, Medical Economics. Work Location: This is a remote position, open to candidates who reside in: Atlanta, GA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote Pay Transparency: The base pay for this role is: $147,549 - $193,658 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: Lead team programs to identify and measure cost-saving initiatives. Provide mentorship, and development planning for team members to promote growth and learning. Maintain current knowledge of medical economics best practices, and work to drive innovation and new approaches. Develop proactive financial models to assess the potential cost and use impacts of proposed clinical programs, network strategies, and policy changes. Conduct sensitivity analyses and stress-testing on models to understand the range of potential outcomes under multiple utilization and cost scenarios. Perform in-depth analysis of integrated claims and operational data — e.g. medical, pharmacy, labs and authorizations) to identify cost and trend drivers. Design and build retrospective studies to measure the actual financial and clinical outcomes of implemented programs, comparing results against initial projections. Promote and shape best practices concerning documentation. Contribute departmental improvements in automation, AI application, and analytic tooling to increase efficiency and the sophistication of your team's work. Serve a trusted analytic business partner and advisor to stakeholders in supported functional units. Maintain relationships, rapport, and lines of communication with stakeholders. Influence and collaborate with partners to guide strategic business decisions with respect to medical expense initiatives. Compliance with all applicable laws and regulations Other duties as assigned Requirements: Bachelor's degree in a STEM field. 7+ years of relevant quantitative analysis experience. Proven experience in health insurance / payer analytics, with an understanding of medical claims data (e.g., CPT/HCPCS, ICD-10, DRGs) and standard healthcare industry data sources. Bonus points: Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one. Experience developing measurement of clinical intervention ROI. Knowledge of prior authorization optimization and automation. Familiarity with pharmacy economics. Background in value-based care analytics. Experience translating between clinical, business, and analytic vocabularies. This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 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. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. 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 (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

Manage and improve risk adjustment models, develop infrastructure recommendations, and support financial and trend analysis. | Requires a bachelor's in a STEM field, 3+ years of related experience, and SOA credentials or progress toward them. | Hi, we're Oscar. We're hiring a Senior Actuarial Analyst to join our Actuarial team. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: The Senior Analyst, Actuarial will play a key role in Oscar’s valuation function, focusing specifically on risk adjustment across all Affordable Care Act (ACA) markets. This role will own the maintenance and review of actuarial models used to develop risk adjustment accrual estimates, forecasting estimates, and various other analyses. This is a very dynamic space, which makes this a great opportunity to work on interesting projects and have a BIG impact. You will report into the Director, Actuarial. Work Location: This is a remote position, open to candidates who reside in: Atlanta, GA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote Pay Transparency: The base pay for this role is: $91,659 - $120,303 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: Model Management: Maintain and enhance core risk adjustment reporting and forecasting models, ensuring consistency and standardization across all team users. Infrastructure & Design: Serve as a key contributor in improving modeling infrastructure; develop recommendations for model design decisions, best practices, and automation/documentation standards. Financial Strategy: Develop recommendations for the risk adjustment accrual setting process and provide data-driven insights for the financial planning process. Trend Analysis: Identify, triage, and investigate core drivers of observed trends across plan designs, providers, vendors, and markets. Stakeholder Engagement: Maintain strong relationships and clear lines of communication with internal and external stakeholders. Team Development: Aid in the onboarding of new analysts by collaborating and integrating them into existing processes. Governance: Compliance with all applicable laws and regulations. Other duties as assigned. Requirements: Bachelor's degree in a STEM field. Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one. 3+ years of experience in a related field. Bonus points: Strong knowledge of core health insurance concepts and experience with actuarial applications. Highly technical with a strong enthusiasm to apply tech-forward methods in actuarial models. This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 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. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. 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 (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

Lead and coordinate cross-functional program implementation, ensure operational efficiency, establish governance, and manage stakeholder collaboration to achieve strategic initiatives. | 4+ years of program/project management and change management experience in health insurance, with strong skills in process improvement and stakeholder engagement. | Hi, we're Oscar. We're hiring a Manager, Strategic Initiatives to join our Enterprise Delivery team. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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 You will be responsible for leading all activities related to program implementation goals to ensure success of large cross-functional programs. You will identify and drive strategic improvements for core operations, including proper controls and monitoring, ensuring operational efficiency and effectiveness. You will oversee and coordinate the program across the organization to implement project management fundamentals across the organization, including establishing efficient governance structures to track progress and ensure appropriate levels of visibility. As a member of the Enterprise Delivery team, you will support business and operations partners in decision making, ensuring collaborative working models, being Oscar's connective tissue to inform work and identify critical interdependencies. You will report into the Senior Director, Strategic Implementation. Work Location: This is a remote position, open to candidates who reside in: Dallas, TX. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. Pay Transparency: The base pay for this role is: $84,240 - $110,565 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities • Organize and lead daily activities for your programs, often acting as the translators of strategy into actionable plans • Identify, develop and implement program strategy, optimizations and tooling that support the organization's objectives • Meet with stakeholders to discuss program status and goals, [helping to guide decisions and creating recommendations when needed] • Oversee implementations end to end to ensure program success [including guiding the development of KPIs and reporting for all levels of the organization] • [Heavy collaboration and partnership] with other departments and various stakeholders to ensure [strategic and] operational excellence • Analyze program risks; ability to anticipate risks and issues. This includes proactive flagging of issues, managing escalations, and tracking and helping to resolve risks and issues. • Ensure proper controls and monitoring are in place for the your program (e.g. management processes and governance structures) • Work with leadership and the program stakeholders to lead program retrospectives and assess program strengths and weaknesses • Ensure proper metrics are in place to measure program success • Compliance with all applicable laws and regulations • Other duties as assigned Requirements • 4+ years of program and project management in the health insurance space • 4+ years experience in change management and process improvement Bonus Points • Healthcare experience • Management consulting This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 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. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. 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 (accommodations@hioscar.com) to make the need for an accommodation known. Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.

Audit prepayment and post payment medical claims to detect fraud, waste, and abuse, develop expertise in coding guidelines, document findings, and support team efficiency and training. | 1+ years auditing experience in multiple specialties, Certified Professional Coder (CPC) certification required, bachelor's degree or 4+ years work experience, with bonus points for fraud and healthcare knowledge. | Hi, we're Oscar. We're hiring a Senior Specialist, Coding Auditor to join our SIU 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 The Senior Specialist works to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to audit prepayment and/or post payment claims. The Senior Specialist runs and coordinates activities across Oscar to reduce the incidence and effect of fraud, waste, and abuse (“FWA”) on all our operations. You will report to the Manager, SIU Coding Audit Post-Pay. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. This is a remote position, open to candidates who reside in the following location(s): Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. While your day-to-day work will be completed from your home office, occasional travel may be required for key team meetings and company events. Pay Transparency The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $63,200 - $82,950 per year. The base pay for this role in all other locations is: $56,800 - $74,655 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities • Develop and maintain a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements. • Perform complex policy updates or audits of assigned documentation (i.e. medical records or claims) on both a prepayment and/or post payment basis to determine accuracy of claims submitted to Oscar. • Document findings including reference to sources used to support decision-making and in a way that can be easily understood by non clinicians or coders. • Create reports and reference guides that can be used by other team members to communicate findings or more effectively perform similar reviews. • Help draft written communications to providers to convey findings. • Participate in educational calls with providers. • Help train new team members. • Develop and document processes to improve the efficiency of the team. • Compliance with all applicable laws and regulations • Other duties as assigned Qualifications • 1+ years of auditing experience across multiple specialties. • Certified Professional Coder (CPC) designation or similar certification (required for SIU) • Bachelor's degree or 4+ years of work experience Bonus Points • Certified Professional Medical Auditor • Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), other coding certifications or similar • Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity • Demonstrated experience translating technical jargon to non-technical end users. • Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting. • Experience with HIPAA, data privacy, and/or data security processes • Experience working with regulators governing (public or private) health insurance carriers This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 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. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. 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 (accommodations@hioscar.com) to make the need for an accommodation known. Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.

Manage clinical programs end-to-end including project planning, stakeholder management, data evaluation, and continuous improvement. | 3+ years program management experience, ability to independently create projects, use data for program improvement, and implement enterprise-wide initiatives. | Hi, we're Oscar. We're hiring an Associate to join our Case Management Programs 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 You will own one or more clinical programs, working cross functionally with internal and external Oscar stakeholders while representing the needs and interests of the department. We ask that you have program design, initiative implementation, with an ability to work across disparate initiatives and stakeholders at the same time. You will work with a clinical dyad partner to manage the assigned clinical programs. You will report to the Senior Manager, Case Management Programs. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role. You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote Pay Transparency: The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $98,400- $129,150 per year. The base pay for this role in all other locations is: $88,560 - $116,235 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses. Responsibilities • Oversee and identify optimization and continuous improvement of program(s). • Lead the end-to-end management of implementations/projects, including detailed project plan creation, stakeholder engagement, and management of cross-functional relationships. • Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data. • Work with all relevant internal and external stakeholder groups to formulate implementation, communications, and program strategies for successful change management and risk mitigation initiatives. • Expert in program(s) who can present to senior leadership on workflow decisions, metrics, and program value. • Mentor team members and promotes colleagues' professional development • Compliance with all applicable laws and regulations • Other duties as assigned Qualifications • 3+ years of experience in program management and program design • 2+ years of experience in creating projects / programs independently and within a team environment • Experience using data to improve programs • Experience implementing enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support Bonus Points • Experience / background in a fast-paced operations environment • Master's Degree • PMP Certifications or Program Management Certifications • Lean/Six Sigma Certifications • Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting) This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 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. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. 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 (accommodations@hioscar.com) to make the need for an accommodation known. Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.