Senior Analyst, Payment Integrity
Core
Subject matter expert for reimbursement policies, payment integrity edits, and claims processing resolution within the Oscar health insurance platform.
Role type
Senior IC payment integrity analyst (health insurance)
Builds
Actionable process improvements, policy language updates, and solutions for adverse claim outcomes
Domain
Health insurance / Medical claims processing
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medical coding (CPC, COC, CCS, RHIT, RHIA), claims processing, auditing, reimbursement methodologies, provider contract concepts, data mining, root cause analysis, SQL
Preferred skills
Six Sigma, Lean, QA analyst, PM, operations analyst, finance, consulting, industrial engineering
Responsibilities
Investigate and resolve disputes regarding policies and edits; research industry coding rules to inform policy language; ingest adverse claim outcomes to identify thematic opportunities; collaborate with partners to scope and deliver solutions; provide training and support for escalated issues
Seniority
Senior, hands-on IC