COB专员，支付完整性
COB Specialist, Payment Integrity
你好，我们是Oscar。我们正在招聘一名COB专家加入我们的支付完整性团队。
Oscar是首家围绕完整技术平台建立的健康保险公司，并始终专注于为会员提供服务。我们在2012年创立Oscar，旨在打造一家我们自己希望拥有的健康保险公司——一家像家庭医生一样的公司。
关于该职位：
你将负责支持支付完整性团队的受益人协调（COB）工作。该职位负责调查和验证Oscar医疗和药品索赔的正确支付。你将创建新的COB工作流程，改进现有流程并推动COB审计。
你将向支付完整性经理汇报工作。
工作地点：这是一个远程职位，面向居住在以下地区的候选人：佐治亚州亚特兰大；伊利诺伊州芝加哥；德克萨斯州达拉斯；肯塔基州路易斯维尔；明尼苏达州明尼阿波利斯；宾夕法尼亚州费城；犹他州盐湖城。你将完全远程办公；但我们的工作方式可能会随时间调整。未来模式可能涉及在与你所在都市区相关的中心办公室进行混合办公。#LI-Remote
薪资透明：该职位的基本薪资为：每年64,832至85,092美元。你还有资格享受员工福利，参与Oscar的无限休假计划以及年度绩效奖金。
职责：
- 作为Oscar COB报销政策的专家，提供专业支持
- 回应有关COB政策的内部和外部查询及争议
- 利用通过研究和索赔审查获得的知识，提出COB机会。转化为业务需求；提交并与其他内部合作伙伴协作以实现变更
- 接收来自内部和外部合作伙伴的负面索赔结果信息；与合作伙伴协作，明确范围、规模、优先级并交付COB解决方案
- 利用合作伙伴提交的信息、流程监控等获得的见解，与团队合作主动识别解决COB问题的主题性机会
- 通过及时向相关方通报进展、状态变化、障碍、完成情况等，持续营造透明和协作的文化；适时解答问题
- 通过提供快速研究、根本原因分析、培训等方式，支持Oscar各州目标的实现，当问题被领导层升级并分配时
- 分析、调查并确认Oscar会员是否存在双重保障
查看英文原文
Hi, we're Oscar. We're hiring a COB Specialist 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:
You will be responsible for supporting Coordination of Benefits (COB) efforts for Payment Integrity. This role is responsible for investigating and verifying proper payment of Oscar medical and pharmacy claims. You will create new COB workflows, enhance existing and drive COB audits.
You will report into the Manager, Payment Integrity.
Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote
Pay Transparency: The base pay for this role is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
Responsibilities:
- Contribute as a subject matter expert for Oscars COB reimbursement policies
- Respond to internal and external inquiries and disputes regarding COB policies
- Use knowledge gained through research and claims review to ideate COB 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 COB solutions.
- Use insights from partner submissions, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve COB 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.
- Analyze, investigate and confirm if dual coverage exists for Oscar membership
- Utilize data analysis skills and tools to develop accurate, quantitative analyses of payment issues
- Compliance with all applicable laws and regulations
- Other duties as assigned
Requirements:
- A bachelor's degree or 4+ years of commensurate experience
- 4+ years of experience in payment integrity, ideally coordination of benefits
- Experience with coordination of benefits 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
Bonus points:
- 2+ years of experience working with large data sets using excel or a database language, preferably SQL.
- Experience with pharmacy coordination of benefits
- Experience in a professional healthcare claims organization
- Knowledge management, training, or content development in operational settings
This is an authentic Oscar Health job opportunity.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.