• Conducting thorough analysis to identify fair market value pricing for investigator services based on study requirements and industry standards. • Collaborating with internal stakeholders to negotiate pricing terms and ensure alignment with study budgets and contractual agreements. • Maintaining documentation and records related to investigator pricing in compliance with regulatory requirements. • Providing support and guidance to internal teams on pricing-related matters and resolving inquiries from stakeholders. • Contributing to the development and enhancement of pricing strategies and processes to optimize efficiency and accuracy.

Our Medicare IT Analyst - Pricing Procedures Analyst is responsible for researching and responding to interdepartmental referrals while ensuring the accuracy and effectiveness of processing and coding guidelines. This Medicare IT Analyst plays a pivotal role supporting internal technology, and systems and will maintain internal manuals, coordinate updates to pricing files in systems like MCS and FISS, and request changes for Pricing File Updates. The Pricing Procedures Analyst requires active participation in weekly Functional Workgroup (FWG) calls and collaboration with other MACs and CMS. Additionally, they support document maintenance and assist the Technical Claims team with various projects and assignments. Salary Range 45,000 ~ $56,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience. We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin How do I know this opportunity is right for me? If you: - Can implement required changes and enhancements to CMS systems, including requesting, validating, and performing maintenance, coding, testing, and validation. Download, verify, and install CMS update files to ensure system accuracy. - Would enjoy reviewing Medicare Part A and Part B claims, including complex and specialty claims, to ensure proper application of processing guidelines, payment rules, and manual calculations to obtain pricing information from Redbook, system files, and CMS resources. - Can address requests for assistance received via OnBase, conducting in-depth research to provide accurate responses related to pricing using CMS and Shared System Maintainers’ resources. - Like reviewing, analyzing, and providing feedback on Fee Schedule Disclosures and pricing articles, ensuring compliance with CMS guidelines and internal procedures. - Can maintain detailed and up-to-date records of all CMS-related changes and updates, and ensure the accuracy of pricing systems, including performing regular testing and validation to address discrepancies. - Would thrive working closely with CMS and Shared System Maintainers to implement and validate system changes, troubleshoot issues, and support the enhancement of pricing systems and processes. Minimum Qualifications - Bachelor’s degree in Health System Information or a related discipline, or equivalent combination of education and experience. - 1 or more years of experience in Medicare Part A and Part B claims processing. - Knowledge of Medicare program and operations, as well as a thorough understanding of claims processing and billing procedures. - Proficient in navigating systems and/or applications to effectively download and install files (i.e., FISS/MCS pricing files). - Strong analytical skills and problem-solving skills. - Demonstrated organizational skills with ability to coordinate and maintain detailed documentation for the implementation of Change Requests and TDLs related to pricing. - Ability to collaborate effectively and provide support to the Technical Claims team with various projects and assignments as needed. Preferred Qualifications - Experience performing yearly Profile Builds related to pricing functions in MCS and FISS. Remote Work Requirements - Wired (ethernet cable) internet connection from your router to your computer - High speed cable or fiber internet - Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net) - Please review Remote Worker FAQs for additional information Benefits - Remote and hybrid work options available - Performance bonus and/or merit increase opportunities - 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately) - Competitive paid time off - Health insurance, dental insurance, and telehealth services start DAY 1 - Professional and Leadership Development Programs - Review additional benefits: (https://www.wpshealthsolutions.com/careers/) Who We Are WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready. Culture Drives Our Success WPS’ culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition. Sign up for Job Alerts FOLLOW US! Instagram LinkedIn Facebook WPS Health Blog This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services.

Hi, we're Oscar. We're hiring a Manager, Pricing Strategy to join our FP&A 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 Manager, Pricing Strategy will manage competitive healthcare portfolio strategies. You must be familiar with advanced financial modeling, using market analytics, and partnering cross-functionally to guide executive pricing decisions. Experience delivering business intelligence that optimizes profitability, informs company-wide strategy, and drives long-term organizational growth. You will report into the Senior Director, Strategic Finance & Corporate Development. Work Location: This is a remote position, open to candidates who reside in: Atlanta, GA. 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. #LI-Remote Pay Transparency: The base pay for this role 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: - Craft recommendations using a data-driven approach combined with business intuition for senior executives to make pricing decisions that affect our growth and bottom-line - Build models and tooling that produce relevant business insights, including competitive intelligence insights and scenario modeling - Collaborate with Actuarial, Regional Leaders, Plan Design and Sales teams to develop portfolio strategy for each Oscar market - Identify and research profitability tradeoffs, market trends, and membership insights to help build company-wide strategic decisions - Source, organize, and analyze data to support all strategic programs in the team - Monitor important metrics and identify emerging trends around the ACA landscape for leadership to help quickly inform tactics during selling season - Report intra-year membership analytics to leadership to understand health of the business - Compliance with all applicable laws and regulations - Other duties as assigned Requirements: - Bachelor's degree in Finance, Economics, or Actuarial or equivalent work experience - 5 + years of finance experience including experience in Healthcare, Consulting, Insurance or Financial Services - 4+ years of experience with google products - Sheets, Docs and Slides or Microsoft products. - 4+ years of experience working with C-level executives. Bonus points: - MBA in finance, MS in Financial Analysis - Experience in the managed care, healthcare or insurance - Proficiency in SQL/BigQuery to analyze large datasets - Proficiency working with NetSuite and Adaptive This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 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. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. 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. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

Hi, we're Oscar. We're hiring a Manager, Pricing Strategy to join our FP&A 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 Manager, Pricing Strategy will manage competitive healthcare portfolio strategies. You must be familiar with advanced financial modeling, using market analytics, and partnering cross-functionally to guide executive pricing decisions. Experience delivering business intelligence that optimizes profitability, informs company-wide strategy, and drives long-term organizational growth. You will report into the Senior Director, Strategic Finance & Corporate Development. Work Location: This is a remote position, open to candidates who reside in: Dallas, TX. 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. #LI-Remote Pay Transparency: The base pay for this role 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: - Craft recommendations using a data-driven approach combined with business intuition for senior executives to make pricing decisions that affect our growth and bottom-line - Build models and tooling that produce relevant business insights, including competitive intelligence insights and scenario modeling - Collaborate with Actuarial, Regional Leaders, Plan Design and Sales teams to develop portfolio strategy for each Oscar market - Identify and research profitability tradeoffs, market trends, and membership insights to help build company-wide strategic decisions - Source, organize, and analyze data to support all strategic programs in the team - Monitor important metrics and identify emerging trends around the ACA landscape for leadership to help quickly inform tactics during selling season - Report intra-year membership analytics to leadership to understand health of the business - Compliance with all applicable laws and regulations - Other duties as assigned Requirements: - Bachelor's degree in Finance, Economics, or Actuarial or equivalent work experience - 5 + years of finance experience including experience in Healthcare, Consulting, Insurance or Financial Services - 4+ years of experience with google products - Sheets, Docs and Slides or Microsoft products. - 4+ years of experience working with C-level executives. Bonus points: - MBA in finance, MS in Financial Analysis - Experience in the managed care, healthcare or insurance - Proficiency in SQL/BigQuery to analyze large datasets - Proficiency working with NetSuite and Adaptive This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 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. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. 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. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.