Jobs at Oscar Health

Supports healthcare provider network growth by executing network construction plans, conducting provider outreach, assisting with contract negotiations, sourcing providers, meeting contracting metrics and SLAs, documenting feedback, and ensuring regulatory compliance. The role is remote within Arizona, Florida, Georgia, or Texas and requires up to 20% travel.

Leads administrative complaints, grievances, appeals, and escalation operations across healthcare insurance lines of business. Oversees compliance, quality, audit readiness, regulatory turnaround times, workforce capacity, vendor performance, and high-risk issue resolution. Manages multi-tiered teams, partners with Claims, Network, Legal, and Compliance, uses case data and Lean methods to address root causes, and presents operational and compliance insights to executive leadership.

Leads Oscar’s provider-facing risk adjustment program, managing strategy, implementation, cross-functional delivery, provider relationships, performance analysis, documentation and coding improvement initiatives. Partners with network, legal, market, data science, and risk adjustment teams to integrate requirements into provider agreements and operating models. Develops reporting, education, engagement, incentives, and mitigation plans while managing risks, dependencies, and stakeholder communications. The role is fully remote in eligible U.S. locations with occasional travel.

Supports health insurance plan and benefit design across multiple markets, translating strategy and regulatory requirements into accurate configurations, filings, and member materials. Partners with actuarial, regulatory, compliance, network, clinical, and operations teams throughout product development and launch. Performs quality assurance, regulatory and competitive analysis, process optimization, risk escalation, and post-launch performance monitoring. Requires expertise in ACA and small-group plan design, cost-sharing, metal tiers, essential health benefits, regulatory filings, and complex cross-system configurations.

Leads innovation and development of health insurance products, including employer-subsidized, ICHRA-aligned, hybrid ACA, and lifestyle-based offerings. Translates strategy into product concepts, business cases, pilots, and scalable market launches. Analyzes employer, broker, member, competitive, and market trends; defines product positioning and growth strategies; coordinates cross-functional teams; and evaluates pilot performance. The role also guides junior team members and partners with sales, actuarial, clinical, network, strategy, and growth teams.

Develops market strategies supporting growth, performance improvement, market expansion, portfolio optimization, and strategic partnerships. Analyzes market dynamics, competitors, regulations, products, and performance; builds business cases; and translates complex data into executive-ready recommendations. Partners with finance, sales, network, product, marketing, clinical, and market leadership teams to guide decisions and transition approved strategies into execution.

Coordinate complex care across inpatient, outpatient, emergency, and home-care settings. Educate members, develop personalized care plans, assess social determinants of health, connect members with community resources, provide crisis intervention, and resolve barriers to treatment. The role also supports compliance, process improvement, and pilot programs while collaborating with members, providers, and internal teams.

Leads regional actuarial pricing strategy for ACA Individual insurance markets, oversees annual CMS and state rate filings, and advises executives through forecasts, reporting, and presentations. Directs advanced analytics on morbidity, competition, pricing, growth, and network strategies. Partners with Finance, Market P&L, Product, Medical Economics, and Government Affairs, supports regulatory advocacy, and mentors the Regional Actuarial team.

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.

Investigate and verify coordination of benefits for medical and pharmacy claims, conduct payment integrity audits, and identify reimbursement opportunities. The role develops and improves COB workflows, analyzes claims data, performs root-cause research, translates findings into business requirements, collaborates with stakeholders, responds to policy inquiries, and supports training and issue resolution while ensuring regulatory compliance.

Manage and negotiate provider contracts for assigned Texas/West markets to build and maintain network adequacy. Analyze provider performance and costs, support network growth and recruiting, resolve provider issues, ensure regulatory compliance, collaborate with provider services, and meet SLAs and metrics.

Manages and negotiates healthcare provider contracts across an assigned region, supporting network growth, regulatory compliance, reimbursement optimization, and cost-saving initiatives. Analyzes provider performance, financial data, claims, and rosters to inform contracting decisions. The role also supports network strategy, provider issue resolution, corrective action plans, process improvements, provider communications, and mentorship of junior team members. Travel may comprise up to 25% of the position.

Leads healthcare network contracting for a defined region, including complex provider negotiations, contract analysis, settlement resolution, regulatory compliance, and network optimization. Manages contracting staff, develops strategies aligned with network adequacy and cost goals, monitors performance metrics, resolves provider issues, and maintains relationships with hospitals, health systems, and national providers.

Supports value-based healthcare contracting by negotiating provider agreements, analyzing provider performance and financial data, ensuring regulatory compliance, growing provider networks, resolving provider issues, and implementing network strategy and cost-saving initiatives. The role also mentors junior staff, monitors network adequacy, supports process improvements, and collaborates with provider services teams. It is remote within specified states and requires frequent local travel for client meetings.

Reviews high-dollar facility bills and claims line by line to identify billing errors, coding issues, improper bundling, and non-covered services. Applies coding systems, reimbursement methodologies, contracts, and payer policies to validate claims and recommend adjustments. Documents savings and findings, supports payment integrity edits, analyzes payment issues, contributes to process improvements, develops business requirements, resolves inquiries, and provides subject matter expertise and training.

Lead execution of insurance product lifecycle overseeing regulatory filing, quality assurance, and operational governance. Collaborate with cross-functional teams and vendors to ensure compliance and effective product implementation.

The role involves driving innovation in insurance product development, managing pilot programs, and collaborating across teams to enhance healthcare solutions.

Develops market-level strategies for growth, retention, competitive positioning, expansion, and portfolio optimization across health insurance markets. Leads market-entry analyses, business cases, strategic initiatives, and multi-year planning while evaluating competitive, provider, regulatory, and financial dynamics. Translates complex market intelligence into executive-ready recommendations and partners with cross-functional leaders to support strategic decision-making and execution.