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

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.

Associate, Regulatory Affairs

Key skills