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Vice President, Payment Integrity

Oscar Health

Oscar Health

Remote
Posted on Thursday, June 22, 2023

Hi, we're Oscar. We're hiring a Vice President, Program Integrity 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

Oscar’s Program Integrity team identifies areas of value leakage in our claims process and executes on initiatives to reduce leakage through edits, document review, and fraud, waste and abuse (FWA) investigation. Leveraging data analysis, coding review, and grit, the leader for Program Integrity will make a meaningful impact on Oscar’s bottom line – and by extension to keep health care costs down.

This role will design and lead Oscar’s Program Integrity processes and cross-functional initiatives, including collaborating with legal / regulatory, data science, claims design, and other areas of Oscar to design, implement, and oversee solutions. You will not only leverage your own experience and industry-standard practices to help Oscar benchmark its Program Integrity activities, but also demonstrate innovation and creativity in exceeding these benchmarks.

You will report into Claims Lifestyle.

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 potential base pay for this role is: $228,000 - $299,250. You are also eligible for employee benefits, ((monthly vacation accrual up to 10 days per year)) ((participation in Oscar’s unlimited vacation program)) ((company equity grants)) and ((annual performance bonuses)) ((sales commissions)).

Responsibilities

  • Design, implement and lead Oscar’s cross-functional Program Integrity efforts
  • Set and meet justifiable and appropriately scaled goals for Oscar’s Program Integrity activities
  • Design and implement measurable, repeatable, and scalable tools and processes always identifying opportunities for efficiency and automation
  • Stay abreast of industry developments, new schemes, and technological and regulatory developments, in order to implement targeted and responsive anti-fraud efforts
  • Evaluate opportunities to build internal capabilities vs. outsource to external vendors to select the optimal model for Oscar to pursue
  • Foster widespread engagement – by internal and external stakeholders – with Oscar’s Program Integrity function
  • Ensure that Oscar meets its legal and regulatory obligations related to Program Integrity
  • Coach, develop and lead a department to successfully achieve team outcomes

Qualifications

  • 15+ years of healthcare experience, preferably in health insurance
  • Specific experience and demonstrated success in Program Integrity
  • Senior level project management experience
  • Robust knowledge of applicable fraud statutes and regulations, and of CMS guidelines
  • 5+ years of leadership experience

Bonus Points

  • CPC, RHIT, RHIA, or other coding or reimbursement experience
  • 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.