[Hiring] Claims Processor @Oscar Health

Role Description

The Claims Processor 1 is responsible for accurately reviewing, processing, and adjudicating health insurance claims in compliance with company policies, contractual agreements, and regulatory requirements. This role ensures timely and accurate claim resolution by:

• Verifying eligibility, benefits, and supporting documentation
• Applying appropriate coding and payment guidelines
• Identifying discrepancies or potential issues for follow-up
• Resolving claim inquiries and providing clarification on claim status
• Supporting prompt reimbursement

You will report into the Claims Lead.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $20 an hour. You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year.

Qualifications

• High School Diploma, GED or equivalent years of experience in data analytics, provider data and/or claims processing
• Strong verbal and written communication skills (Bonus points)
• Ability to take direction and navigate through multiple systems simultaneously (Bonus points)
• Ability to solve problems within pre-defined methods and guidelines (Bonus points)
• Ability to review claims and analyze critical data (Bonus points)
• Experience with navigating claims resolution systems (Bonus points)
• An Associate or Bachelor's degree in Business, Accounting, Finance, Economics, Healthcare, Public Policy, Technology or Math (Bonus points)
• Advanced Google Suite or Microsoft Office capabilities or willingness to learn (Bonus points)
• In-depth knowledge of Health Insurance operations processing protocols and payment schemes (Bonus points)
• Experience manipulating and entering accurate data in a production driven environment (Bonus points)
• Experience handling Personal Health Information (PHI) in a professional manner (Bonus points)
• Demonstrated capacity to balance competing priorities and continue to execute projects with excellence (Bonus points)

Requirements

• Compliance with all applicable laws and regulations
• Responsible for the accurate and timely processing of claims
• Research and processes claims according to business regulation, internal standards and processing guidelines
• Resolves system edits, audits and claims errors through research and use of approved references and investigative sources
• Contribute to the reduction of the daily inventory through processing claims
• Contribute to team-wide goals that support the success of Claims Productions daily operations
• Other duties as assigned

Benefits

• Medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance
• Paid wellness time and reimbursements