Senior Analyst, Regulatory Affairs at Oscar · Lumi · Lumi

Responsibilities

The Senior Analyst, Regulatory Affairs is a contributor and owner of mission critical workflows to maintain and operate 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. You will keep tabs on developments to No Surprises Act policies and support the Regulatory Affairs function in serving as an enterprise wide resource on public policy and IDR trends.
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: $79,488 - $104,328 per year. The base pay for this role in all other locations is: $71,439 - $93,895 per year. You are also eligible for employee benefits, participation in Oscar s unlimited vacation program and annual performance bonuses.
Serve as the subject matter expert on assigned state and federal policy for provider dispute and IDR legislative matters, while applying newly proposed and effective laws and regulations to processes as appropriate in assigned jurisdictions.
With support from team leads, prepare clear, concise, user friendly briefing based upon case needs.
Deliver multiple, simultaneous and diverse assignments while adhering to strict deadlines and managing competing priorities in a fast-paced environment.
Serve as a point of contact for provider negotiations relating to IDR.
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

Senior Analyst, Regulatory Affairs

Responsibilities

Qualification

Required

Preferred

Benefits

Company

Oscar

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