Claims Operations Associate Jobs in Keller, TX (NOW HIRING)

Hi, we're Oscar. We're hiring an Associate, Actuarial to join our Actuarial team.

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 Actuary supports Oscar's Network Performance and Value-Based Care (VBC) strategy by developing actuarial analyses, financial models, and performance insights that inform provider arrangements and total cost of care (TCoC) initiatives. You will partner with Network Contracting, Actuarial, Finance, Clinical, and Claims Operations stakeholders to evaluate deal economics, monitor results, and translate complex healthcare data into clear recommendations. You will work independently on well-defined analyses, brings rigor to recurring processes, and helps improve the accuracy, automation, and documentation of VBC analytical outputs.

You will report into the Associate Director, Medical Economics.

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: $123,372 - $161,925 per year. The base pay for this role in all other locations is: $111,034 - $145,733 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Develop, maintain, and enhance actuarial models used to evaluate VBC arrangements, including shared savings, shared risk, and capitated payment structures.
• Forecast deal performance, calculate settlement outcomes, and assess the financial impact of alternative reimbursement models on TCoC and affordability goals.
• Monitor provider and arrangement performance through recurring reporting, benchmarking, attribution, and variance analysis; identify drivers of emerging results and opportunities for improvement.
• Partner with Network Contracting, Actuarial, Finance, Clinical, and Claims Operations teams to support contract evaluation, negotiation strategy, and ongoing performance management.
• Translate complex claims, utilization, and financial data into concise insights and recommendations for business partners and leadership.
• Strengthen actuarial best practices by improving model documentation, QA controls, reproducibility, and automation of recurring analyses.
• Support onboarding and knowledge sharing for analysts by documenting processes and helping teammates understand established analytical methods.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• College degree in a STEM field.
• Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one.
• 4+ years of quantitative analysis experience.

Bonus points:

• Experience in health insurance, value-based care, provider economics, medical economics, or network performance analytics.
• Strong understanding of core health insurance concepts, including claims, utilization, risk adjustment, reimbursement, and total cost of care.
• Experience with SQL, Python, R, or other analytical tools used to build repeatable models and reporting.
• Excellent communication, collaboration, and relationship-building skills, including the ability to explain technical analyses to non-technical audiences.
• Experience improving analytical processes through automation, documentation, and quality controls.