Senior Analyst, Payment Integrity Disputes

ABOUT THE ROLE Oscar Health is seeking a Senior Analyst, Payment Integrity Disputes to strengthen its Disputes team. The role focuses on ensuring accurate payment processing for Oscar’s insurance business by investigating, resolving, and improving payment integrity disputes within the claim environment. The position reports to the Manager, Payment Integrity (Pre‑Pay) and is fully remote, open to candidates worldwide. WHAT YOU'LL DO You will act as a subject‑matter expert on Oscar’s reimbursement policies, payment integrity disputes, and claim editing processes. Your responsibilities include responding to internal and external inquiries, researching coding rules, and translating findings into actionable policy and workflow enhancements. You will collaborate with cross‑functional partners to scope, prioritize, and implement solutions that reduce adverse claim outcomes. Additionally, you will conduct root‑cause analyses, provide training, and maintain transparent communication with stakeholders to keep projects on track. Compliance with all applicable laws and regulations is a core part of the role. WHAT YOU'LL NEED - Minimum four years of experience in claims processing, coding, auditing, or healthcare operations, with at least three years in medical coding. - A medical coding certification from AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA). - Proven knowledge of reimbursement methodologies, provider contract concepts, and standard claims resolution practices. - At least two years of experience extracting business insights from datasets and improving business workflows. - Strong collaboration skills with internal and external stakeholders. - Bonus qualifications include experience in technical or process‑improvement roles, large‑dataset analysis with Excel or database languages, professional healthcare claims experience, knowledge‑management or training roles, Lean Six Sigma or similar training, and SQL proficiency. WHY REMOTE This role is designed for a fully remote workforce, allowing you to work from any location while contributing to Oscar’s mission to transform health care through technology and member focus. BENEFITS Eligible full‑time employees receive medical, dental, and vision coverage, 11 paid holidays, paid sick time, paid parental leave, a 401(k) plan, life and disability insurance, and paid wellness time and reimbursements. The base salary ranges from $64,832 to $85,092 per year, with eligibility for annual performance bonuses and an unlimited vacation policy.