Senior Analyst, Payment Integrity Disputes
Core
Senior Analyst supporting payment integrity disputes and issue resolution in the Oscar health insurance claim environment.
Role type
Senior IC payment integrity analyst (disputes & appeals)
Builds
Payment integrity solutions and process improvements for Oscar Insurance
Domain
Health insurance / Claims processing / Medical coding
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Payment integrity disputes, claims processing, medical coding, reimbursement methodologies, provider contract concepts, data mining, root cause analysis, stakeholder collaboration
Preferred skills
Technical role experience (QA, PM, operations), SQL, Excel/database languages, Lean Six Sigma, knowledge management
Technologies
SQL, Excel, database languages
Responsibilities
Scope, triage, investigate, and execute solutions for payment integrity disputes; research industry coding rules and input into reimbursement policy; ingest adverse claim outcomes and prioritize solutions; proactively identify thematic opportunities via data mining and process monitoring; support leadership escalations with research and root cause analysis
Seniority
Senior, hands-on IC