Oscar Health · 18 hours ago

Senior Claims Quality Control Analyst

United States

Full-time

Remote

Mid, Senior Level

$73K/yr - $96K/yr

4+ years exp

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Responsibilities

Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.

Utilize data analysis skills and tools to develop accurate, quantitative analyses of issues.

Translate observations, findings and analysis results into detailed–often technical–business requirements; submit to and collaborate with internal partners to effectuate change.

Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.

Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.

Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.

Compliance with all applicable laws and regulations

Other duties as assigned

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claims processingAuditingData analysisExcelDatabase languageWorkflow improvementStakeholder collaborationTechnical role experienceProcess improvementLean Six SigmaSQLHealthcare operationsData backgroundHealthcare backgroundEngineering background

Required

A bachelor’s degree or 4+ years of commensurate experience

3+ years experience in a claims processing environment and/or auditing within claims in healthcare operations

2+ years of experience working with large data sets using excel or a database language

1+ 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

Preferred

2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)

An academic and/or professional background in engineering, data, or healthcare

Experience in a professional healthcare claims organization

Process Improvement or Lean Six Sigma training

Experience using SQL