Claims Processor I

Hi, we're Oscar. We're hiring a Claims Processor 1 to join our Claims 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

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; and identifying discrepancies or potential issues for follow-up. The role works to resolve claim inquiries, provide clarification on claim status, and support 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.

Responsibilities

• 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.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements

• High School Diploma, GED or equivalent years of experience in data analytics, provider data and/or claims processing

Bonus points

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

This is an authentic Oscar Health job opportunity.

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.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

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 (accommodations@hioscar.com) to make the need for an accommodation known.

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