Associate, Medicare Compliance

Tempe, Arizona, us
Company: Oscar Technology
Category: Management Occupations
Published on 2021-07-31 22:04:05

Hi, we're Oscar. We’re hiring an Associate to join our Compliance 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:

Oscar’s Compliance Department manages and mitigates regulatory risk as we serve ever more members and clients across in ever more markets.  The Compliance Department also proves to our state and federal regulators and exchanges that we can fulfil our core regulatory obligations while providing members with higher-quality, lower-cost care.

As a Medicare Compliance Associate, you will focus on Compliance activity particular to Oscar’s Medicare Advantage (MA) line of business.  You will liaise with Oscar’s federal regulator, CMS, to ensure the compliant delivery of materials and services to MA plan members.  You will help set the standards for, and monitor the performance of, Oscar’s tech platform (called “+Oscar”) as it services Oscar’s own MA plans, as well as those offered by +Oscar’s clients and strategic partners.  

You will report to the Director of Medicare Compliance.

Responsibilities:

  • Support the Director of Medicare Compliance in preparing reports to the Boards of Oscar’s licensed insurance entities, maintaining Oscar’s relationship with CMS, and responding to audit and enforcement activities.
  • Provide MA-related advisory, investigatory, and remedial support services – partnering with the Legal Department where appropriate – to Oscar’s MA Product, Regional P&L, Insurance Operations, Clinical Services, Member Services, Sales, Finance, and Tech teams.
  • Digest regulatory updates from CMS and disseminate them to operational teams, tracking and where appropriate monitoring implementation.
  • Review MA marketing materials for adherence to applicable requirements before submitting them to CMS on Oscar’s behalf.
  • Prepare agendas, materials, and participants for regular Account Management calls with CMS.
  • Advise Compliance colleagues on the development of audit tools to assess MA compliance.

Requirements:

  • Bachelor’s Degree or equivalent work experience.
  • 4+ years’ experience in health plan (ideally MA) compliance, regulatory affairs, government affairs, or a similar field.
  • Experience with MA rules, including the Medicare Managed Care Manual and Prescription Drug Benefit Manual
  • Experience managing complicated projects, keeping track of details, and staging work to deliver projects on time.
  • Experience articulating regulatory requirements to business and technical staff to capture information and achieve results.
  • Experience with developing reporting and metrics.

Bonus points:

  • CHC, CCEC, or similar
  • Experience with HIPAA, data privacy, and/or data security processes
  • Prior experience working with regulators on compliance audits, reporting and other matters – ideally in the MA space.
  • Experience in a TPA and/or start-up setting

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 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.

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