Oscar Insurance is hiring a

Clinical Review Processor

Tempe, United States

Hi, we're Oscar. We’re hiring a CRT Processor to join our Clinical Review Team (CRT) team in our Tempe office. 

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 and headquartered in New York City. Our goal is to make health insurance simple, transparent, and human. We need your help to do so.

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 help to build clinical review cases, communicate with providers and facilities (via phone or email), coordinate with our clinicians and other Oscar teams, and ensure compliance to state regulations and NCQA standards. 

Developed a comprehensive understanding of Oscar's clinical review processes and overall workflow. Learned to use our internal tools to manage your work and resolve or escalate issues as needed. Begun to form relationships with fellow processors, the clinical reviewers (nurses and physicians), and essential external partners. Become comfortable working with providers by phone and in writing. Afterward and on an ongoing basis: You continue to... 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 the cause to guide 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 panel. Support regulatory audits as needed

You will report to the Associate Ops Manager.

Responsibilities:

  • Developed a comprehensive understanding of Oscar's clinical review processes and overall workflow
  • Learned to use our internal tools to manage your work and resolve or escalate issues as needed
  • Begun to form strong working relationships with fellow processors, the clinical reviewers (nurses and physicians), and key external partners
  • Become comfortable interacting with providers via phone and in writing

Requirements:

  • 1+ years of health insurance or healthcare experience 

Bonus points:

  • Bachelor’s degree 
  • Knowledge of authorization processing and medical terminology
  • In-depth knowledge of UM authorization processing
  • Experience handling Personal Health Information (PHI) in a professional manner
  • Experience entering accurate data in a production-driven environment

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 an 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.