Manager, Data Mining - Payment Integrity

Hi, we're Oscar. We're hiring a Manager, Data Mining to join our Payment Integrity team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Manager of Data Mining leads a team of individual contributors, ensuring the team is meeting savings and recovery targets in the payment integrity space. You will lead data mining auditors in the post-payment payment integrity space, and oversee data mining vendor management.

You will report into the Associate Director, Payment Integrity.

Work Location: This position is based in our New York City office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid

Pay Transparency: The base pay for this role is: $111,780 - $146,711 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

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)