The Senior Specialist is responsible for supporting process improvement and issue resolution within the Special Investigations Unit (SIU) by analyzing workflows and platform logic. They will collaborate cross-functionally to translate stakeholder friction into actionable technical requirements and drive cost-optimization initiatives.
The Case Manager coordinates care across various settings and partners with members to create personalized care plans that improve clinical outcomes. They also assess Social Determinants of Health and provide crisis intervention to resolve barriers to care.
The Lead APP will provide direct patient care via telemedicine while supervising a multidisciplinary team of Advanced Practice Providers, Registered Nurses, and Medical Assistants. They are responsible for clinical quality, developing clinical guidelines, and participating in collaborative projects with Operations and Product teams.
The Associate, Itemized Bill Reviewer performs line-by-line audits of high-dollar facility bills to identify coding errors and ensure accurate claim payments. They also serve as a subject matter expert to refine internal audit processes and collaborate with stakeholders to improve payment integrity solutions.
Maintain and enhance valuation models for ACA markets, including models used for IBNR projections and risk adjustment accruals, and contribute to regulatory filings and strategic valuation recommendations. Analyze experience across plans, providers, vendors, and markets; improve automation and documentation practices; and support stakeholder relationships and analyst onboarding.
The analyst will maintain and enhance core valuation models while developing recommendations for IBNR projections and risk adjustment accruals. They will also contribute to regulatory filings and promote actuarial best practices across the team.
The manager will conduct primary and secondary market research to support insurance product strategy and market-level decision-making. They will analyze healthcare market trends, consumer behaviors, and competitor activity to provide actionable insights for business partners.
Investigate and resolve payment integrity issues, respond to policy and claims-edit inquiries, and recommend improvements to reimbursement policies and processes. Use partner feedback, data analysis, and process monitoring to identify opportunities, define business requirements, collaborate across teams, and keep stakeholders informed.
Develop and optimize staffing schedules using forecast volumes, arrival patterns, employee considerations, and stakeholder requirements to meet service-level and efficiency targets. Monitor queues and staffing in real time, identify performance trends and issues, and communicate recommendations while coordinating with internal support teams and stakeholders.
The Senior Specialist manages the provider contracting lifecycle to ensure network adequacy and operational accuracy. They collaborate with internal departments and external providers to maintain contracting data and support strategic recruitment initiatives.
The Senior Manager leads a team of analysts to oversee pricing models and rate development for ACA markets. They act as a key partner to cross-functional teams to ensure sustainable growth and provide strategic actuarial guidance.
The role involves managing an assigned caseload of members, brokers, and providers while maintaining service delivery and quality expectations. You will also monitor work-in-progress issues, participate in process improvement projects, and ensure compliance with regulatory standards regarding personal health information.
The role involves managing an assigned caseload of members, brokers, and providers while maintaining service delivery and quality standards. You will also monitor work-in-progress issues, participate in process improvement projects, and ensure compliance with regulatory standards.
The role involves managing assigned caseloads and interacting with members, brokers, and providers to ensure high-quality service delivery. You will also monitor work-in-progress issues, participate in process improvement projects, and ensure compliance with regulatory standards.
The role involves managing assigned member caseloads and interacting with brokers, providers, and vendors through multiple channels. You will also monitor work-in-progress issues, ensure compliance with health information standards, and participate in process improvement projects.
The Associate drives solutions to acute and systemic operational issues by managing provider escalations and orchestrating cross-functional efforts. They also utilize data to inform business decisions and develop strong relationships with internal and external stakeholders.
The Associate drives solutions to acute and systemic operational issues by managing provider escalations and orchestrating cross-functional efforts. They also utilize data to inform business strategy and develop trusting relationships with internal and external stakeholders.
Define and execute the product strategy and roadmap for Virtual Care while prioritizing investments based on clinical outcomes and member experience. Lead cross-functional teams to improve the member journey and build efficient tools for clinicians to deliver high-quality care.
Define and execute the product strategy and roadmap for Oscar Virtual Care to improve member access and clinical delivery. Lead cross-functional teams to identify opportunities for technology integration, measure impact, and optimize the end-to-end member journey.
The Senior Manager will lead the development of risk score predictions and ACA market morbidity analysis while collaborating with cross-functional teams. They are responsible for maintaining core risk adjustment models, supporting monthly financial closes, and ensuring accurate financial reporting through audit deliverables.
The Senior Director leads the ACA risk adjustment actuarial function, overseeing financial reporting, forecasting, and strategic analysis. They manage cross-functional partnerships and provide actionable insights to senior leadership to inform business strategy.
The Senior Analyst will support valuation processes by establishing IBNR projections and risk adjustment accruals for ACA markets. They will also investigate performance trends to inform financial planning, pricing, and company strategies.
The Senior Analyst will manage valuation processes, including IBNR projections and risk adjustment accruals for ACA markets. They will also leverage SQL and Python to drive insights, support regulatory filings, and contribute to financial planning.
Review pricing and plan design models, analyze performance and trends, and provide actuarial insights to support pricing strategy and regulatory filings. Promote actuarial best practices in automation and documentation, maintain stakeholder relationships, and help onboard analysts.
Review pricing and plan design models, analyze performance and trends, and provide actuarial insights to support pricing strategy. Contribute to regulatory filings, improve actuarial automation and documentation practices, maintain stakeholder relationships, and help onboard analysts.
Lead analysts and oversee regional pricing and end-to-end rate development for Oscar’s ACA markets, including regulatory submissions, pricing models, trend analysis, and market risk monitoring. Partner with business and cross-functional stakeholders to guide pricing and product strategy, support sustainable growth, and mentor analysts while promoting actuarial best practices.
The Senior Director will define and execute the provider experience strategy while leading cross-functional initiatives to improve provider engagement. This role involves leveraging data to drive insights, managing strategic projects, and advocating for provider needs across the organization.
The Senior Director will define and execute the provider experience strategy by collaborating with cross-functional leaders to drive impactful initiatives. This role involves leveraging data to identify strategic opportunities, managing high-visibility projects, and advocating for the provider experience across the organization.
The Associate Director leads a team of actuarial professionals to manage pricing for ACA markets and provide strategic financial recommendations to senior management. They are responsible for overseeing end-to-end pricing processes, mentoring staff, and collaborating across departments to support business growth.
The Manager, Actuarial leads a team of analysts to oversee pricing and rate development for ACA markets while ensuring actuarial soundness. They collaborate with cross-functional partners to guide strategic business decisions and maintain regulatory compliance.
The Director, Actuarial will lead a team to manage regional pricing, drive strategic decisions, and ensure regulatory compliance across multiple states. They will also collaborate with cross-functional teams in finance and product development while mentoring actuarial staff.
Oversee the investigation and resolution of critical operational bottlenecks, errors, and escalations, using data to identify risks and inform technology-enabled solutions. Coordinate projects and collaborate with leadership and cross-functional teams to improve processes, meet service levels, manage costs, and support compliant, high-quality operations.
Handle high-volume member, broker, provider, and vendor interactions across multiple channels while managing assigned cases and related back-office tasks. Track work in progress, meet service and quality expectations, escalate and resolve issues, support process improvements, and comply with privacy, regulatory, and operational standards.
Handle high-volume member, broker, provider, and vendor interactions across multiple channels, while completing related back-office tasks and managing an assigned caseload. Track work-in-progress issues, meet service and quality expectations, escalate and resolve problems, support process improvements, and comply with operational, regulatory, and privacy requirements.
Handle high-volume member, broker, provider, and vendor interactions across multiple channels, while managing assigned cases and back-office tasks to meet service, productivity, and quality expectations. Track work-in-progress issues, escalate and resolve them within required turnaround times, support process improvements, and comply with operational, regulatory, and PHI standards.
Handle high-volume member, broker, provider, and vendor interactions across multiple channels while managing assigned cases and back-office tasks. Track work in progress, resolve or escalate issues, meet service and quality expectations, support process improvements, and comply with operational and privacy requirements.
The specialist will resolve complex issues for members and providers while managing a caseload and contributing to knowledge management systems. They will act as a liaison between internal teams to identify trends and improve the overall service experience.
The Lead manages a team responsible for provider data and production workflows, ensuring operational efficiency and performance against KPIs. They provide coaching, drive team engagement, and collaborate across departments to implement best practices and resolve operational gaps.
The Associate Manager leads a team responsible for accurate and timely provider credentialing, re-credentialing, and provider enrollment operations. This role oversees production metrics, quality standards, and cross-functional partnerships to ensure regulatory compliance and network readiness.
The role involves managing the configuration and maintenance of authorization workflows, rulesets, and automations within the Utilization Management platform. You will also investigate system escalations, perform root cause analysis, and act as a subject matter expert to educate cross-functional teams.
You will manage the configuration and maintenance of authorization workflows, rulesets, and automations within the Utilization Management platform. Additionally, you will investigate system escalations, perform root cause analysis, and educate cross-functional teams on system logic.
The Senior Director will lead a multi-disciplinary team to build and scale an operating model for escalated provider issue resolution. They will partner across various departments to identify, route, resolve, and prevent provider issues while driving operational improvements.
Lead a multi-disciplinary team to build and scale an operating model for escalated provider issue resolution and root-cause remediation. Partner with cross-functional departments to improve operational handoffs, reduce avoidable escalations, and drive enterprise-wide improvements.
The CGA Team Lead supervises daily production operations and provides guidance to staff to ensure compliance with state and federal regulatory requirements. They are responsible for monitoring performance metrics, facilitating case resolution, and leading process improvement projects to enhance the member experience.
The CGA Team Lead supervises daily production operations, ensuring compliance with state and federal regulations for complaints, grievances, and appeals. They provide coaching to staff, manage team performance metrics, and facilitate process improvements to enhance the member experience.
The Contract Load Representative is responsible for validating, configuring, and maintaining executed provider contracts and amendments within internal systems. They collaborate with cross-functional teams to ensure data accuracy and resolve complex provider and member issues.
Provide high-quality, evidence-based virtual urgent care to patients using audio, video, and written communication. Collaborate with a multidisciplinary care team to manage patient health goals, follow up on diagnostics, and ensure closed-loop communication.
The Lead APP will provide direct patient care via telemedicine while overseeing a multidisciplinary team of providers. They are responsible for clinical quality, developing care guidelines, and serving as an escalation point for the virtual health assessment program.
Provide high-quality, evidence-based virtual urgent care to patients using audio, video, and written communication. Collaborate with a multidisciplinary care team to manage patient health goals and ensure closed-loop communication.
Provide virtual medical care to members via phone and messaging while adhering to company guidelines and policies. Collaborate with a multidisciplinary team of MAs, RNs, and other providers to ensure high-quality, efficient patient care.
Provide direct oversight and supervision of nurse practitioners and physician assistants while delivering virtual medical care via phone and video. Collaborate with multidisciplinary teams to ensure high-quality care in alignment with company guidelines and regulatory standards.
Provide virtual medical care to patients via phone and messaging while adhering to company guidelines and policies. Collaborate with a multidisciplinary team including medical assistants and registered nurses to ensure high-quality care delivery.
The Senior Manager will lead and optimize revenue cycle operations, including billing, coding, and claims management for the Oscar Medical Group. They will develop scalable strategies and partner with cross-functional teams to improve financial performance and documentation accuracy.
The Senior Manager will lead and optimize revenue cycle operations, including billing, coding, and claims management across the Oscar Medical Group. They will develop scalable strategies and partner with cross-functional teams to improve financial performance and ensure compliance.
The Senior Analyst investigates and detects aberrant behavior in claims and enrollment data to identify Fraud, Waste, and Abuse (FWA). They manage investigative caseloads from identification to resolution while developing documentation and reporting to meet monetary and savings targets.
The Specialist supports the design and execution of network construction plans and manages provider outreach to meet defined metrics and SLAs. They also assist in contract negotiations and document provider feedback to improve internal processes.
The auditor conducts internal and external quality audits of ICD-10 code abstraction to ensure accuracy and identify clinical documentation improvement opportunities. They also manage risk adjustment operations, including medical record reviews and CMS audit activities, while reporting trends to leadership.
Provide virtual medical care and direct oversight of nurse practitioners and physician assistants in accordance with state regulations. Collaborate with multidisciplinary teams to ensure high-quality care delivery and compliance with company policies.
The Associate Director provides strategic leadership and operational oversight for administrative grievances, appeals, and escalations to ensure regulatory compliance and operational excellence. They manage high-performing teams, drive resolution for complex member issues, and collaborate with cross-functional partners to mitigate risk and improve processes.
The manager leads the strategy and execution of provider-facing risk adjustment initiatives while managing cross-functional program delivery. They are responsible for establishing provider engagement models, analyzing performance data, and driving measurable improvements in documentation and coding outcomes.
The role involves leading the annual operating plan cycle and partnering with business leaders to translate company priorities into financial targets. You will also drive strategic investment processes by building business cases and evaluating trade-offs to support resource allocation.
The role involves leading the annual operating plan cycle and partnering with business leaders to translate company priorities into financial targets. You will also drive strategic investment processes by building business cases and evaluating trade-offs to support resource allocation.
The Medical Assistant provides virtual support to a Care Team by collecting patient medical information and performing administrative tasks. They manage patient needs from initial outreach to resolution, including scheduling, referrals, and coordinating with external facilities.
Provide direct oversight and regulatory supervision of nurse practitioners and physician assistants across virtual service lines. Collaborate with multidisciplinary teams including MAs and RNs while ensuring compliance with all applicable healthcare laws and regulations.
The Manager supports the development of health insurance plan designs by translating market strategy and regulatory requirements into detailed benefit configurations. They partner with cross-functional teams to ensure accuracy in filings, system configurations, and member-facing materials while driving process improvements.
The Senior Manager leads the development and advancement of insurance lifestyle product concepts, translating corporate strategy into scalable market-ready solutions. They are responsible for guiding matrixed teams, managing the product roadmap, and executing pilots from brainstorming through launch.
Provide high-quality, evidence-based virtual care to patients using audio, video, and written communication. Collaborate with a multidisciplinary care team to manage complex patients and participate in operational workflow improvements.
Provide high-quality virtual patient care and conduct health assessments while collaborating with a multidisciplinary team of physicians and clinicians. Manage patient follow-ups, utilize remote diagnostic tools, and participate in operational meetings to improve clinical workflows.
Provide high-quality virtual patient care and conduct health assessments as part of a collaborative care team. Participate in operational workflows, patient huddles, and maintain compliance with all applicable healthcare laws.
Provide high-quality virtual care and perform health assessments for insurance members while collaborating with a multidisciplinary care team. Manage patient follow-ups, utilize remote diagnostic tools, and participate in clinical meetings to improve operational workflows.
Provide high-quality virtual patient care and conduct health assessments while collaborating with a multidisciplinary team of physicians and clinicians. Manage patient follow-ups, diagnostic monitoring, and contribute to operational workflow improvements.
Provide high-quality virtual patient care and conduct health assessments as part of a collaborative medical team. Manage patient follow-ups, utilize remote diagnostic tools, and participate in operational workflows to improve service delivery.
Provide high-quality virtual care and conduct health assessments for insurance members. Collaborate with a multidisciplinary team to manage patient care, labs, and diagnostics.
The Market Medical Officer serves as the clinical executive for the Texas and West region, partnering with P&L leadership to drive market performance and enhance care affordability. This role bridges corporate operations with local provider leadership to optimize medical cost trends and ensure regional network adequacy.
The Market Medical Officer serves as the clinical executive for the Atlantic region, leading market performance, care access, and affordability initiatives. They partner with P&L leadership to optimize medical cost trends and bridge corporate operations with local provider leadership.
The Market Medical Officer serves as the clinical executive for the Central region, partnering with P&L leadership to drive market performance, care access, and affordability. They are responsible for optimizing medical cost trends, managing provider relationships, and ensuring regional compliance with state and federal regulations.
The Associate Director develops and advances market strategies to improve growth, performance, and expansion across the company's insurance portfolio. They translate complex data into actionable recommendations and collaborate with cross-functional leadership to shape business decisions.
The Senior Analyst supports the accuracy, quality, and compliance of credentialing and provider operations through audits and performance analytics. They translate data findings into actionable process improvements and provide subject-matter expertise on practitioner and facility credentialing requirements.
The Case Manager coordinates care across various settings and partners with members to create personalized care plans that improve clinical outcomes. They also assess Social Determinants of Health and provide crisis intervention to resolve barriers to care.
The Case Manager coordinates care across various settings and partners with members to create personalized care plans that improve clinical outcomes. They also assess Social Determinants of Health and provide crisis intervention to resolve barriers to care.
The Senior Director leads the execution and continuous improvement of the enterprise compliance program, including risk assessments, policy governance, and regulatory change management. They also partner with cross-functional leaders to mitigate compliance risks and advise senior leadership on complex healthcare regulatory matters.
The Senior Director will lead the execution and continuous improvement of the enterprise compliance program, including risk assessments, policy governance, and regulatory change management. They will also serve as a trusted advisor to senior leadership, overseeing compliance investigations and fostering a culture of ethics and integrity across the organization.
Provide strategic leadership to the Clinical Policy team by ensuring medical and pharmacy policies are evidence-based and aligned with clinical advancements. Direct clinical publishing efforts and serve as a cross-functional scientific authority to elevate care quality across the organization.
Provides strategic leadership for provider clinical regulatory programs, credentialing operations, and clinical policy guidance. Ensures enterprise compliance with NCQA, CMS, and state standards while optimizing provider onboarding processes.
The Associate manages and negotiates contracts with healthcare providers to build and maintain a robust network while ensuring cost optimization and regulatory compliance. They also support network growth through direct provider engagement and data-driven analysis of provider performance.
The Senior Director will lead end-to-end corporate development activities, including M&A, investments, and strategic partnerships. They are responsible for market mapping, financial modeling, and ensuring successful transaction execution and integration.
The Senior Director will lead the company's inorganic growth agenda, including M&A, strategic partnerships, and investments from sourcing through execution. They will also manage long-term financial modeling and collaborate with operators to ensure successful post-close integration and value capture.
The Provider Network Associate supports the accessibility and quality of the provider network through recruitment, engagement, and education activities. This role involves leveraging demographic data to target provider outreach and managing relationships to meet network growth and medical cost targets.
The Associate Manager will lead, coach, and develop a team to support lean operations while driving productivity and process efficiencies. They are responsible for managing team reporting, analyzing KPIs, and collaborating with stakeholders to implement program strategies and risk mitigation.
The Associate Director leads a team of analysts to investigate regulatory inquiries and ensure adherence to state and federal claims compliance standards. This role translates departmental strategy into actionable business plans while collaborating cross-functionally to improve operational performance and regulatory outcomes.
The Associate Director leads a team of analysts to investigate regulatory inquiries and ensure adherence to state and federal claims compliance standards. This role collaborates cross-functionally to translate departmental strategy into actionable business plans while managing regulatory exams and operational KPIs.
The Manager of Data Mining leads a team of auditors to meet savings and recovery targets within the payment integrity department. They are responsible for overseeing vendor submissions, developing team workflows, and partnering with data science teams to establish identification algorithms.
The Clinical Pharmacist Supervisor manages a team of pharmacists to ensure clinical accuracy and efficiency in prior authorization and appeals workflows. They also provide coaching, monitor performance metrics, and collaborate on process improvements to meet organizational quality standards.
Provide high-quality, evidence-based virtual urgent care to health insurance members using audio, video, and written communication. Collaborate with a multidisciplinary care team to manage patient health, follow up on diagnostics, and improve operational workflows.
Provide virtual patient care via phone and messaging while adhering to Oscar Medical Group guidelines and policies. Collaborate with a multidisciplinary team including MAs, RNs, and other providers to ensure high-quality, efficient healthcare delivery.
Provide high-quality, evidence-based virtual urgent care to patients using audio, video, and written communication. Collaborate with a multidisciplinary care team to manage patient health, follow up on diagnostics, and ensure closed-loop communication.
The Associate is responsible for negotiating and managing healthcare provider contracts to build and maintain a robust network while optimizing costs. They also support network growth, mentor junior team members, and ensure compliance with regulatory guidelines.
The Manager of Network Contracting leads a team in negotiating and managing complex healthcare provider contracts to meet accessibility and financial goals. They are responsible for dispute resolution, ensuring regulatory compliance, and optimizing network performance through data-driven strategies.
The Director will drive the strategy, program design, and implementation of initiatives within the Provider Integration and Experience department. They are responsible for enhancing provider experience, managing cross-functional initiatives, and reporting on business health to senior leadership.
The Director will drive the strategy, program design, and implementation of initiatives within the Provider Integration and Experience department. They are responsible for enhancing provider experience, managing cross-functional initiatives, and reporting on business health to senior leadership.
The Manager of Network Contracting leads a team to negotiate and analyze contracts with healthcare providers while ensuring network adequacy and financial goals are met. They are responsible for dispute resolution, maintaining provider relationships, and implementing contracting strategies to support company growth.
The Behavioral Health Physician Reviewer oversees utilization management, case management, and quality improvement programs to ensure clinical and operational performance. They provide clinical determinations based on evidence-based criteria and manage escalated cases including denials and appeals.
The Senior Manager leads a team in negotiating and executing complex healthcare provider contracts to meet financial and network adequacy goals. They also oversee dispute resolution, ensure regulatory compliance, and drive contracting strategies in partnership with market leaders.
The associate will develop and execute network strategies by negotiating and managing partnerships with hospitals and health systems. They will analyze provider performance and financial data to provide recommendations for senior leadership while ensuring network adequacy and affordability.
The Pharmacy Technician Supervisor leads daily operations for the prior authorization team, ensuring accurate and compliant case processing. This role mentors staff, optimizes workflows, and serves as a subject matter expert for escalated inquiries.
The Associate leads cross-functional projects to improve data processes and directory accuracy while resolving complex escalations. They also analyze departmental data to inform technology-enabled solutions and mentor team members to optimize operational efficiency.
The associate leads cross-functional projects to resolve data process challenges and improve directory accuracy. They also analyze departmental performance data to implement technology-enabled solutions and drive continuous improvement.
The Senior Manager leads a team in negotiating and executing complex contracts with healthcare providers to meet financial and network adequacy goals. They are responsible for dispute resolution, contract optimization, and driving contracting strategies in alignment with company objectives.
The Manager of Network Contracting leads a team to negotiate and analyze complex healthcare provider contracts while ensuring network adequacy and financial goals are met. They are responsible for dispute resolution, maintaining provider relationships, and implementing contracting strategies to support company growth.
The associate will perform line-by-line reviews of high-dollar facility itemized bills to identify billing errors and ensure claims are paid accurately. They will also serve as a subject matter expert to translate stakeholder friction into actionable process improvements.
The Associate will support financial planning, analytics, and business insights for various divisions while partnering with leadership on projections and strategic initiatives. They are responsible for creating reporting, monitoring business metrics, and crafting data-driven recommendations to influence growth and profitability.
The Associate will support financial planning, analytics, and business insights for various divisions while partnering with leadership on projections and strategic initiatives. They will also craft data-driven recommendations and monitor key metrics to guide company-wide strategic decisions.
The Associate leads end-to-end cross-functional projects and process improvements to support organizational goals. They are responsible for analyzing departmental metrics, managing stakeholder relationships, and developing strategies for risk mitigation and change management.
The Associate leads cross-functional projects to design and optimize internal processes while managing stakeholder relationships and project governance. They are responsible for analyzing departmental metrics and developing strategies to improve operational performance and mitigate risks.
The Senior Manager develops and executes market-level strategies to drive growth, retention, and competitive positioning across the product portfolio. They lead strategic initiatives, perform market analyses, and provide actionable recommendations to executive leadership.
Define and design user experiences for the Lucie Marketplace, focusing on ICHRA tooling to support Oscar's mission. Collaborate with cross-functional teams including product managers, engineers, and data scientists to drive features from discovery through delivery.
Define and design intuitive experiences for Oscar's users, focusing on the ICHRA marketplace and employer health plan contribution tools. Partner with cross-functional teams including product managers, engineers, and data scientists to drive features from discovery through delivery.
The role involves architecting resilient cloud infrastructure and leading technical projects to support the company's health insurance platform. You will mentor engineers, drive technical roadmaps, and ensure system reliability through robust automation and observability practices.
The role involves architecting resilient cloud infrastructure and leading technical projects to support the company's health insurance platform. You will mentor engineers, drive technical roadmaps, and ensure system reliability through SRE best practices.
Lead the design and implementation of cross-functional processes to optimize member and provider services. Analyze departmental performance data to develop metrics and risk mitigation strategies for organizational goals.
The Associate supports financial planning, analytics, and business insights for corporate, operations, and technology divisions. Key duties include creating reporting for spending patterns, developing portfolio strategies, and providing data-driven recommendations for pricing decisions.
Support financial planning, analytics, and business insights for corporate, operations, and technology divisions. Create reporting and data-driven recommendations to guide pricing decisions and strategic growth for senior leadership.
Own the end-to-end development and performance of insurance plan designs across assigned markets, translating strategy into compliant benefit structures. Lead the product lifecycle from design and regulatory filing through implementation and post-launch optimization.
Lead the execution of the ACA individual and small group QHP product lifecycle, overseeing regulatory filing delivery and quality assurance. Serve as the central hub between Product, Technology, Actuarial, and external vendors to ensure compliant and accurate product implementation.
Conduct primary and secondary market research to analyze healthcare trends, consumer behaviors, and competitor activity. Translate complex data into strategic insights and dashboards to support insurance product development and business planning.
Lead intelligence programs to monitor market trends, competitor strategies, and regulatory developments within Oscar's operating geographies. Translate market insights into strategic recommendations to improve product retention, growth, and portfolio performance.
Lead market-specific strategy development and own the enterprise market intelligence function to guide product strategy and expansion. Serve as a strategic advisor to executive leadership by translating complex data into actionable recommendations for portfolio optimization.
You will perform frequent case reviews, check medical records, and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on research results for those conditions.
The Associate is responsible for leading Coordination of Benefits efforts within the claims and Payment Integrity space. This includes providing thought leadership for Payment Integrity processes and workflows, and identifying overpayments to support overall payment integrity.
