Associate, Payment Integrity (Data Mining)

<p>Hi, we're Oscar. We're hiring an Associate, Data Mining to join our Payment Integrity team.</p> <p>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.</p> <p><strong>About the role:</strong></p> <p>The Associate, Data Mining ensures payment integrity data mining programs are running smoothly and effectively. The Associate is a subject matter expert for the team and a key stakeholder in facilitating vendor and internal payment integrity programs. The Associate, Data Mining provides thought leadership for processes and workflows that impact payment integrity and improve data mining solutions.</p> <p>You will report into the Senior Manager, Payment Integrity</p> <p><strong>Work Location: </strong>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</p> <p><strong>Pay Transparency: </strong>The base pay for this role is: $87,188 - $114,434 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.</p> <p><strong>Responsibilities:</strong></p> <ul> <li>Provide subject matter expertise and in-depth understanding of data mining workflows and program rules.</li> <li>Identify payment integrity solution issues that require action and provide steps needed to remediate the issue.</li> <li>Identify claims with post-payment errors and facilitate processes to recover payments and ensure future payment accuracy</li> <li>Represent data mining payment integrity solutions in payment policy discussions and when necessary, document new policies or modifications to existing policies.</li> <li>Provide training and education to team members when necessary.</li> <li>Serve as a subject matter expert using internal and external tools in order to complete audits and provide guidance to team members.</li> <li>Serve as an in-house expert on data structure and visualization for various stakeholders in service operations.</li> <li><em>Facilitate quality review and validation of data mining concepts and overpayment identifications</em></li> <li>Compliance with all applicable laws and regulations.</li> <li>Other duties as assigned</li> </ul> <p><strong>Requirements:</strong></p> <ul> <li>3+ years of experience in claims processing, auditing or health care operations.</li> <li>3+ years of experience in building or supporting data mining payment integrity solutions.</li> <li>Proven ability to work independently to drive projects to completion.</li> <li>Some coding experience or database language exposure</li> </ul> <p><strong>Bonus points:</strong></p> <ul> <li>Bachelor’s degree </li> <li>3+ years of related work experience in analytics or operations</li> <li>Experience with claims pricing algorithms and/or software</li> <li>Experience using SQL</li> </ul><div class="content-conclusion"><p><span style="font-weight: 400;">This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud</span><a href="http://hioscar.com/careers/recruitment-fraud-alert"><span style="font-weight: 400;"> </span><span style="font-weight: 400;">here</span></a><span style="font-weight: 400;">. </span></p> <p><span style="font-weight: 400;">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.</span></p> <p><strong> ... (truncated, view full listing at source)