Manager, Data Mining - Payment Integrity

United States·New Yorkmid

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Quick Summary

Key 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,

Requirements Summary

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,

Technical Tools

OtherManager

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

~1 min read

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.

Responsibilities

~1 min read

→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

~1 min read

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

Nice to Have

~2 min read

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)

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

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.

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