Associate, Regulatory Affairs

Hi, we're Oscar. We're hiring an Associate, Regulatory Affairs to join our Regulatory Affairs.

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 Associate, Regulatory Affairs, is a major contributor and owner of mission-critical workflows to manage the Independent Dispute Resolution process. In assigned jurisdictions, you will intake disputes from providers, engage in negotiation with business unit support, perform all relevant admin functions, and ultimately prepare arbitration briefing where needed, all while creating and maintaining detailed documentation for tracking purposes. You will work with Regulatory Counsel to update workflows, keep tabs on developments to No Surprises Act policies, and support the Regulatory Affairs function by serving as an enterprise wide resource on IDR trends.

You will report into the Director, Regulatory Affairs.

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.

If you live within commutable distance to our New York City office (in Hudson Square) or our Tempe office (off the 101 at University Ave), you will be expected to come into the office at least three days each week. Otherwise, this is a remote / work-from-home role.  Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. 

Pay Transparency: The base pay for this role in the states of New Jersey and New York is: $96,876 - $127,149 per year. The base pay for this role in all other locations is: $87,188 - $114,434 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Be the subject matter expert on assigned state and federal policy for provider dispute and IDR matters, while applying newly proposed laws and regulations to processes in assigned jurisdictions.
• Prepare concise, user-friendly briefing based on case needs.
• Be the team resource through mentoring team members, maintaining workflows, and work cross functionally to implement solutions where needed.
• Partner with PRO Counsel, Regulatory Affairs colleagues, and cross functional business partners to problem solve and stand up new processes.
• Support + optimize sustainable processes which simplify our growing team's outputs while ensuring high quality deliverables.
• Manage projects with notable complexity with business area implications, developing action plans and managing from start to completion.
• Deliver multiple, simultaneous and diverse assignments while adhering to strict deadlines.
• Support cross-training, and knowledge development across Oscar
• Perform eligibility reviews of disputed claims to ensure all cases are routed to the appropriate venue
• Manage the end-to-end administrative lifecycle of each dispute by maintaining real-time updates on project management boards, gathering and redacting member documentation, and uploading supporting evidence to the appropriate portal stages within set regulatory deadlines
• Independently manage workload and related dependencies in compliance with required regulatory timelines
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Bachelor's degree in the humanities, legal studies, political science, public policy, public administration, public health or other relevant field, or a combination of education and experience.
• 3+ years of legal or regulatory experience, ideally in the health plan/managed care space.
• 2+ years experience working with state and federal political and legislative processes.
• 2+ years experience, legislative tracking software, and Google Workspace.
• 2+ years experience with insurance claims, appeals or regulatory complaints.

Bonus points:

• Experience working with Independent Dispute Resolution is a huge plus
• Experience working in personal injury law firms or as a paralegal
• Familiarity with the Affordable Care Act and the No Surprises Act Experience with Oscar markets.
• Experience working with attorneys and internal stakeholders.