Oscar Health · 18 hours ago
Associate, Payment Policy
Tempe, Arizona, United States
Full-time
Hybrid
Mid Level
$80K/yr - $105K/yr
4+ years expOscar is a health insurance company focused on serving its members through a technology platform. The Payment Policy Associate will manage and execute payment policy activities, ensuring alignment with industry standards and internal practices while collaborating with internal teams.
Health CareHealth InsuranceInsuranceInsurTech
Responsibilities
Provide subject matter expertise and in-depth understanding of Payment Integrity internal claims processing edits, external vendor edits and Oscar reimbursement policies
Analyze data mining and process monitoring to pinpoint claims payment issues, then define the scope and steps for policy remediation
Examine industry standards to confirm claim payments align with industry best practices, internal policies, and regulations—both industry-wide and Oscar-specific
Respond to internal and external inquiries and disputes regarding policies and edits
Document industry standard coding rules and draft recommendations on reimbursement policy language and scope
Ideate payment integrity opportunities based on a deep knowledge of industry standard coding rules. Translate into business requirements; submit to and collaborate with internal partners to effectuate change
Attend regulation update meetings and relay information to team members, providing training and education as needed
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
Required
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
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
3+ year(s) ability to work independently to drive projects to completion
Preferred
3+ years of experience working with large data sets using excel or a database language
Knowledge management, training, or content development in operational settings
Process Improvement or Lean Six Sigma training
Experience using SQL
Benefits
Employee benefits
Participation in Oscar's unlimited vacation program
Annual performance bonuses
Medical, dental, and vision benefits
11 paid holidays
Paid sick time
Paid parental leave
401(k) plan participation
Life and disability insurance
Paid wellness time and reimbursements
Company
Oscar Health
Oscar is a health insurance company that offers individual and family plans, medicare advantages, and small group products.
1001-5000 employees
H1B Sponsorship
Oscar Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (19)
2024 (24)
2023 (22)
2022 (36)
2021 (13)
Funding
Current Stage
Public CompanyTotal Funding
$1.99BKey Investors
Tiger Global ManagementAlphabetFounders Fund
2025-09-16Post Ipo Debt· $355M
2021-03-03IPO
2020-12-17Private Equity· $140M
Leadership Team
Mark Bertolini
Chief Executive Officer
Steven B. Kelmar
Executive Vice President & COS
Recent News
Sherwood News
2026-01-09
Company data provided by crunchbase