Functional Analyst responsible for banking project analysis and functional specifications in São Paulo. Collaborating between business areas, end users, and technical teams with effective communication.
About the role
- Senior Analyst focusing on payment integrity disputes at Oscar Health. Responsible for supporting issue resolution and leading process improvements in claims environment.
Responsibilities
- Support payment integrity disputes and issue resolution in the Oscar claim environment
- Scope, triage, investigate and execute on solutions and process improvements
- Leverage understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc.
- Work cross-functionally and translate friction from stakeholders into actionable opportunities for improvement
- Report into the Manager, Payment Integrity (Pre-Pay)
Requirements
- Experience in Payment Integrity focused on Disputes and/or appeals
- 4+ years of experience in claims processing, coding, auditing or health care operations
- 3+ 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.
- 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 external stakeholders
Benefits
- Health insurance
- Participation in Oscar's unlimited vacation program
- Annual performance bonuses
- 401(k) plan participation
- Paid parental leave
- Paid sick time
- Paid wellness time and reimbursements
- 11 paid holidays
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