Operational Compliance Manager

Oscar, New York

A better kind of health insurance company

Hi, we’re Oscar. We’re a fully licensed health insurer. Our goal is to make healthcare simple, transparent, and human.

We are changing how health insurance works by creating a healthcare experience that’s intuitive and puts people, not cost or workflows, first. We’re using a consumer-focused and tech-driven approach to do so. This positions us uniquely in the space - and creates one of the biggest opportunities in healthcare.

We brought together leaders from top technology, service and healthcare companies to deliver on our promise and seize this opportunity. We all work side by side in a collaborative, energetic, and creative environment. The result: better people, better ideas, and better healthcare.

In this role, you will play an essential role in managing our Individual and Small Group businesses. The Clinical Review team is one of Oscar’s most important clinical functions - we encourage evidence-based practice through utilization review to ensure our members get access to the right care - particularly those who need it most. You will be responsible for understanding and helping to operationalize our regulatory requirements in Individual and Small Group businesses.

This is an exciting opportunity to be at the forefront of growth at Oscar, helping enable our innovative model reach new members.

Deliverables: What you have to achieve

Here at Oscar we move quickly and are perpetually introducing new ideas. We need you not only to be able to think analytically and strategically, but, just as important, to execute on those ideas.

During your first six weeks, you should have:

  • Developed an in depth understanding of the regulatory requirements in the states we operate in
  • Developed an in-depth understanding of our clinical review workflows and data
  • Begun to independently respond to escalated issues requiring analysis
  • Begun to develop working relationships with key internal stakeholders (Compliance, Legal, Quality, Ops, and Tech functions)
  • Begun to develop familiarity with our library of documentation, including Policies and Procedures

Afterwards and on an ongoing basis, you will:

  • Ensure the clinical review team is compliant to all regulations by identifying requirements and driving operational efforts to ensure compliance
  • Serve as project manager for the team during regulatory audits
  • Manage the development and maintenance of policies and procedures
  • Help the clinical review team prepare for expansion into new markets
  • Work with your operational colleagues and the clinicians to deliver on continuous process improvement, from identifying pain points to developing and implementing solutions

Winning factors: What leads to success

We’re looking for someone with 5-6 or more years of experience in a Healthcare setting. Must-have qualifications and expertise include:

  • 2-3 years of Project Management experience 
  • Structured/analytical thinking and problem-solving skills
  • Ability to break down complex processes and communicate them and your ideas simply and clearly
  • A curious mind and innate passion for making things work better
  • Acute attention to detail

We think it will make a big (positive) difference if you have:

  • Utilization Management (UM) experience
  • A Bachelor's Degree
  • Regulatory or compliance experience
  • Experience translating requirements into operations and workflows
  • Experience working in a fast-moving, collaborative environment

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we work to cultivate an environment where exceptional people can be their most authentic selves and find both belonging and support. We're on a mission to change healthcare -- an experience made whole by your unique background and perspectives.

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 ([email protected]) to make the need for an accommodation known.

Pay Transparency Policy: Oscar's Pay Transparency Policy ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

About Oscar

Founded in 2012, Oscar is probably the last thing you would expect from a technology startup – a seemingly old-fashioned healthcare insurance provider. The company provides clients with the kind of clarity and simplicity we have come to expect from an e-commerce site. And, of course, they're hiring.

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Want to learn more about Oscar? Visit Oscar's website.