Manager, Data Mining - Payment Integrity

About the role:

Responsibilities:

• Oversee the quality control process for data mining vendor submissions, ensuring accuracy and alignment with program standards
• Lead the daily operations of the data mining team, including the strategic delegation of work to both internal auditors and external partners
• Develop team workflows and guidelines that produce consistent and measurable outcomes.
• Train, teach and mentor team members to become more proficient and effective.
• Partner with Oscar's technology and/or data science teams to establish algorithms for savings and recovery identifications.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor’s degree or 4+ years of commensurate experience
• 4+ years experience in healthcare operations
• 2+ years of experience leading and developing a team
• 2+ years experience designing, implementing and improving business workflows
• Bonus points:
• 2+ years of payment integrity experience at a health plan or vendor organization
• Experience with healthcare claims adjudication
• Experience with SQL and basic SQL abilities
• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
• This is an authentic Oscar Health job opportunity.
• 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.
• Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
• 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 ([email protected]) to make the need for an accommodation known.
• California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.