Support Coordination of Benefits efforts for Payment Integrity
Investigate and verify proper payment of Oscar medical and pharmacy claims
Report to the Senior Manager, Payment Integrity
Analyze, investigate and confirm if dual coverage exists for Oscar membership
Support leadership to scope, size, prioritize items and deliver Coordination of Benefits solutions
Utilize data analysis skills and tools to develop accurate, quantitative analyses of payment issues
Complete quality reviews of coordination of benefits vendor findings
Ensure compliance with all applicable laws and regulations
Other duties as assigned
Requirements
2+ years of experience in Payment Integrity
1+ years in claims processing, auditing or health care operations
2+ years of experience working with large data sets using excel or a database language
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.
Some experience using SQL (bonus)
2+ years of related work experience in Coordination of Benefits (bonus)
Benefits
Employee benefits
Monthly vacation accrual at a rate of 15 days per year
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
Remote / work-from-home or hybrid work arrangements
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