Associate, Payment Integrity
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Oscar HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims processing and medical coding, with a strong focus on payment integrity and reimbursement methodologies. Proven ability to improve workflows, collaborate with stakeholders, and leverage data for actionable insights.
Highest-signal resume keywords
Claims ProcessingMedical Coding CertificationPayment IntegrityProcess ImprovementData Analysis
Tech Stack
Tools & technologiesAbout the role
Key responsibilities & impact- Support process improvement and issue resolution in the Oscar claim environment for Oscar Insurance and +Oscar clients
- Organize, scope, prepare, investigate and/or execute solutions and process improvements within edits and ideation
- Leverage Oscar’s claim infrastructure, workflows, workflow tooling, platform logic and data models
- Work cross-functionally to translate stakeholder friction into actionable improvement opportunities
- Provide subject matter expertise on Payment Integrity claims processing edits, external vendor edits and Oscar reimbursement policies
- Respond to internal and external inquiries and disputes regarding policies and edits
- Document industry-standard coding rules and recommend reimbursement policy language and scope
- Ideate payment integrity opportunities, translate them into business requirements and collaborate with internal partners to implement change
- Ingest partner information regarding adverse claim outcomes; scope, size, prioritize and deliver solutions
- Use partner submissions, data mining and process monitoring to identify thematic opportunities
- Keep stakeholders informed of progress, status changes, blockers and completion
- Provide research, root cause analysis and training for escalated issues
- Comply with all applicable laws and regulations
- Perform other duties as assigned
Requirements
What you’ll need- A bachelor’s degree or 4+ years of commensurate experience
- 4+ years of experience in claims processing, coding, auditing or health care operations
- 4+ years experience in medical coding within payment integrity
- Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
- Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices
- 2+ years experience deriving business insights from datasets and solving problems
- 1+ years experience improving business workflows and processes
- 1+ years experience collaborating with internal and/or external stakeholders
- Process Improvement or Lean Six Sigma training is a bonus
- Experience using SQL is a bonus
Benefits
Comp & perks- Employee benefits
- Unlimited vacation program
- Annual performance bonuses
- Medical benefits
- Dental benefits
- Vision benefits
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life insurance
- Disability insurance
- Paid wellness time and reimbursements
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingMedical CodingAuditingReimbursement MethodologiesBusiness Insights DerivationWorkflow ImprovementSQL
Soft Skills
CollaborationProblem SolvingCommunication
Tools & Technologies
Workflow ToolingData Models
Certifications & Qualifications
AAPC Certification (CPC, COC)AHIMA Certification (CCS, RHIT, RHIA)
Industry Keywords
Health Care OperationsPayment Integrity ClaimsProvider Contract ConceptsCoding RulesRegulatory Compliance