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Medicare Advantage Regulatory Manager

Oscar is a new kind of health insurance company. We're using technology, data, and design to revolutionize healthcare. We've brought together a talented team that is passionate about helping people navigate the complex and confusing healthcare industry. Oscar is dedicated to offering a simpler and more human health insurance experience - our Concierge and Complaints & Grievances teams are critical in achieving that mission. As an insurance company, we are subject to regulatory and filing requirements by state and federal agencies. In the Medicare Advantage Regulatory Manager role, you will be responsible for all Regulatory issues that touch our Concierge and Complaints & Grievances department (at state and CMS level). As a regulatory expert, you will understand and anticipate upcoming audits, information requests, and/or investigations. You'll be a cross-functional player and collaborate with other departments to ensure we have proper documentation for all agency requirements during and between audits.
Deliverables and Responsibilities:
Familiarize yourself with Oscar's departments and functions, identifying current Complaints & Grievances processes that can be leveraged for Medicare Advantage and identifying gaps in performance against CMS standards
Develop a work plan to address gaps and implement required Complaints & Grievances policies and procedures/programs for full implementation of Medicare Advantage as of October 1, 2019
Maintain calendar and databases for filings and other regulatory requirements that touch the Complaints and Grievances and Concierge departments
Work cross functionally with Legal and Compliance in preparing, compiling, and/or managing regulatory submissions such as CMS universes, annual reporting etc.
Develop streamlined process for collecting audit materials and getting necessary updates to materials or internal workflows from stakeholders
Develop policies relevant to Complaints and Grievances and Concierge processes which meet regulatory requirements and Medicare Advantage requirements
Project manage all Medicare Advantage regulatory projects, assigning department owners and ensuring deadlines are met within Concierge Services
Represent the Complaints and Grievances department during regulatory/compliance meetings or as directed by the Sr. Manager of Complaints and Grievances
Work with relevant Oscar departments to support them through building operational processes and monitoring that meet and exceed regulatory expectations
Think critically about all workflows and materials the Complaints and Grievances team touches; Own making recommendations and ensuring changes are executed for any that do not meet regulatory standards
Be a market expert -- understand the regulatory bodies and their requirements for all markets Oscar operates in or is expanding to; Interact and build relationships with regulators and government agencies
About you:
You have 3 or more years of experience directly related to this role including Medicare Advantage experience
Knowledgeable of Medicare, Medicaid and Affordable Care Act rules and regulations relating to the Complaints & Grievances processes.
You have experience working with CMS and/or other regulatory bodies
You are highly organized and detail oriented, with strong follow through skills. You have no problem working autonomously and managing competing demands and shifting priorities
You love to get into the weeds when needed, and are excited about making a tight project plan and keeping team members accountable
You like to work cross functionally and manage deliverables from different departments
You're open to change -- we're working in an ever changing environment. We're expanding our offerings rapidly, and need a team member to keep us in check from a regulatory perspective as we do
You have excellent communication skills (both written & verbal) and have a proven ability to build strong relationships
You love to learn! You are excited about diving deep into the details of what it means from a compliance & regulation perspective as we enter new markets or areas of healthcare
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we work to cultivate an environment where exceptional people can be their most authentic selves and find both belonging and support. We're on a mission to change healthcare -- an experience made whole by your unique background and perspectives.
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's Pay Transparency Policy 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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