Hi, we're Oscar. We're hiring a Clinical Review Processor to join our Clinical Review team.

Oscar is the first health insurance company built around a full stack technology platform and a 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

We deal with our members' most sensitive issues and are looking for someone who can contribute positively to the level of work we do. You will oversee and coordinate clinical review cases from intake to notification. To do this, you will help build clinical review cases, communicate with providers and facilities (by phone or email), coordinate with our clinicians and other Oscar teams, and ensure compliance to state regulations and NCQA standards.

You will report to the Clinical Review Team Lead. This is a remote role, you will work remotely in one of the following states: Arizona, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.

Responsibilities

• Develop a comprehensive understanding of Oscar's clinical review processes and overall workflow.
• Learn to use our internal tools to manage your work and resolve or escalate issues.
• Build relationships with fellow processors, the clinical reviewers (nurses and physicians) and external partners.
• Become comfortable working with providers by phone and in writing.
• Answer questions on the clinical review process for in-network and out-of -network services.
• Support the team's development and continuous operational improvement by raising issues and identifying root cause to create resolution.
• Take ownership of all authorization processing issues; monitoring, tracking, and statusing the health of the operation.
• Coordinate with our concierge teams to assist with discharge planning and any other UM needs of members on their panelSupport regulatory audits

Qualifications

• 1+ years of health insurance or healthcare experience
• Knowledge of UM authorization processing
• Experience handling Personal Health Information (PHI)
• Experience entering accurate data in a production-driven environment

Bonus Points

• Bachelor's degree
• Knowledge of authorization processing and medical terminology

Life at Oscar

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.

We encourage our members to care for their whole selves, and we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

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

Pay Transparency Policy

Oscar 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.