Oscar Health · 9 hours ago
Senior Analyst, Payment Integrity
Tempe, Arizona, United States
Full-time
Hybrid
Mid, Senior Level
$65K/yr - $85K/yr
4+ years expOscar is a health insurance company that focuses on serving its members through a technology-driven platform. The Senior Analyst, Payment Integrity will support process improvement and issue resolution within the claims environment, leveraging a deep understanding of Oscar's infrastructure to drive actionable opportunities for improvement.
Health CareHealth InsuranceInsuranceInsurTech
Responsibilities
Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits
Respond to internal and external inquiries and disputes regarding policies and edits
Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope
Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change
Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions
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
Required
A bachelor's degree or 4+ years of commensurate experience
3+ years of experience in claims processing, coding, auditing or health care claims operations
3+ 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
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)
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 ManagementBaillie Gifford,CoatueAlphabet
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
The Motley Fool
2026-02-02
2026-01-17
2026-01-16
Company data provided by crunchbase