Specialist, Risk Adjustment

Hi, we're Oscar. We're hiring a Specialist, Risk Adjustment to join our Risk Adjustment 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 Specialist, Risk Adjustment for the Affordable Care Act (ACA) line of business supports the Risk Adjustment team and management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing effective Risk Adjustment processes. You will provide support to our daily operations and deliverables related to our Retrospective and/or Prospective Risk Adjustment Programs.

You will report into the Manager, Risk Adjustment Retrospective.

Work Location: This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role in the states of New Jersey and New York is: $29.86 - $39.19 per hour. The base pay for this role in all other locations is: $26.87 - $35.27 per hour. You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

Support daily operations pertaining to Risk Adjustment including but not limited to: medical record retrieval, provider outreach, researching contact information, creating provider level reports and presentations.

Maintain a grasp of our medical records inventory and deliverables to ensure we are keeping/exceed pace against goal

Make outreach to internal and external partners to improve our ability to hit retrieval goals

Represent Risk Adjustment to our internal and external partners and help influence positive outcomes

Support team with monitoring, tracking, and statusing our inventory

Develop an in-depth understanding of day-to-day workflows at Oscar

Become acquainted with internal tools and technical processes, and highlight areas of opportunity for improvement

Support your manager by guiding decisions on an ongoing basis

Compliance with all applicable laws and regulations

Other duties as assigned

Requirements:

Bachelor's degree in a relevant field of study or commensurate work experience.

1+ years experience in chart retrieval or provider outreach

1+ years of experience in Healthcare Operations

2+ years of experience with being held to and accomplishing goals

Bonus points:

1+ years of experience in risk adjustment

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here . 

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.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy .