Clinical Review Processor

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

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. In this role, you will be responsible for owning and coordinating clinical review cases from intake to notification. To do this, you will 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 workflowLearned to use our internal tools to manage your work and resolve or escalate issues as neededBegun to form strong working relationships with fellow processors, the clinical reviewers (nurses and physicians) and key external partnersBecome comfortable interacting with providers via phone and in writingAfterwards and on an ongoing basis:You continue to...Be able to answer questions on the clinical review process for in-network and out-of -network servicesSupport the team's development and continuous operational improvement by raising issues and helping to identify root cause to drive resolutionTake ownership of all authorization processing issues; monitoring, tracking, and statusing the health of the operationCoordinate with our concierge teams to assist with discharge planning and any other UM needs of members on their panelSupport regulatory audits as needed

You will report to the Clinical Review Team Lead.

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
• 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

Bonus points:

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

Life at Oscar: 

Our more than 1,000 employees aim to make health care affordable and accessible for all. We apply this same vision to our perks and benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

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 your unique background and perspectives.

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.

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.