Teams at Oscar Health

Supports payment integrity through claims research, coding and reimbursement policy expertise, issue resolution, root cause analysis, process improvement, and business requirements development. Investigates claim outcomes, evaluates internal and vendor edits, identifies opportunities using data and process monitoring, and collaborates with stakeholders to implement solutions. The role also responds to policy disputes, supports escalated issues, and ensures regulatory compliance.

Supports provider network development for a health insurer by recruiting, engaging, and educating providers; targeting network adequacy needs; assessing provider capabilities; conducting outreach and meetings; maintaining CRM data; guiding providers through network participation; and improving workflows while ensuring regulatory compliance. The role is remote but field-based and requires travel of up to 75%.

Manages provider operations teams, including coaching, hiring, performance management, KPI reporting, data analysis, root-cause analysis, process improvement, change management, and risk mitigation. Partners with stakeholders to improve productivity, client satisfaction, operational efficiency, and compliance while ensuring team outputs meet departmental objectives.