Claims Configuration Tester

Hi, we're Oscar. We're hiring a Configuration Tester to join our Claims 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

The Claims Configuration Tester Is a key contributor to the Claims and Benefits team.  The role is focused on the on-going evaluation of pricing and configuration for new and existing claims rules.  The associate will be responsible for ensuring that pricing rules deliver intended outcomes.

You will report to the Director of Payment Integrity.

This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $76,000 - $99,750 per year. The base pay for this role in all other locations is: $68,400 - $89,775 per year. You are also eligible for employee benefits, and annual performance bonuses.

Responsibilities

• Assist in the on-going evaluation of pricing and configuration for new and existing claims business rules including member benefits, claims editing, reference data and system functionality within the claims processing system. 
• Analyze explanation of coverage documents to assist with determining best approach for configuring benefits offered including member cost shares, deductibles and out-of-pocket maximums. 
• Assist in the setup of code sets and defining pre-authorization guidelines used in claims configuration to drive application of medical policy and accurate claims payment. 
• Liaison with applicable departments to gather claims configuration requirements and provide feedback to stakeholders regarding feasibility of claims business rule and program changes. 
• Collect and analyze data to assess and resolve operational obstacles to claims configuration design optimization. 
• Perform root-cause analysis on claims configuration issues across all products, document results and present business impact analysis for proposed claims configuration changes. 
• Develop explanatory information for other departments to better understand claims configuration across products. Identify ways to enhance performance management and operational reports related to new claims configuration processes. 
• Monitor existing system functionality and make claims configuration recommendations, where appropriate, to maintain acceptable levels of automation in claims adjudication and accurate claims payment. 
• Create and run queries to assist with configuration design, unit test configuration, and root cause incorrect configuration
• Create test scripts, including regression testing cases, to validate claims configuration against source documentation. 
• Assist with organizing the release of claims configuration changes to production to reduce the potential for migration conflict. 
• Ensure the quality and integrity of claims configuration change requests using production validation and audit strategies. Provide informational updates to management as available and/or assigned. 
• Additional duties as assigned 

Qualifications

• A bachelor’s degree or 4+ years of commensurate experience
• 2+ years of work experience
• Experience in analytics & ability to derive insights from complex, broad datasets
• Proficiency in designing and improving workflows
• Experience in internal and external stakeholder management

Bonus Points

• Proficiency in medical terminology, medical coding (CPT4, ICD9 or ICD10, and HCPCS), provider contract concepts and common claims processing/resolution practices.
• Experience utilizing analysis tools such as SQL, AWS, Python, and/or Looker
• Experience with spreadsheet functions that include creating standardized reports, utilizing vLookups, pivot tables, filtering and formulas to generate desired results. 

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