Senior Director, Escalated Provider Issue Resolution

Hi were Oscar. Were hiring a Senior Director Escalated Provider Issue Resolution to join our Network & Provider Management 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 ourselvesone that behaves like a doctor in the family.

About the role:

The Senior Director Escalated Provider Issue Resolution team supports strategic provider accounts high-complexity escalations root-cause remediation and provider service governance. This role will build and scale the operating model for escalated provider issue resolution lead a multi-disciplinary team and partner across Claims Network Utilization Management Payment Integrity Contact Center Account Management Technology Analytics and senior leadership to improve how Oscar identifies routes resolves and prevents provider issues. This position will report to the SVP Network and Provider Management.

You will report into the Vice President of Provider Integration & Experience.

Work Location:This is a remote position open to candidates who reside in: Dallas Texas. 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: $196732 - $258211 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program company equity grants and annual performance bonuses.

Responsibilities:

• Lead and develop a multi-disciplinary provider issue resolution organization including teams focused on strategic provider support complex issue resolution root-cause remediation and provider service governance.
• Build a scalable operating model for escalated provider issues including intake standards triage criteria escalation pathways ownership expectations service metrics and closure practices.
• Oversee resolution of high-impact provider issues that require coordination across multiple operational teams.
• Partner with leaders across Claims Network Utilization Management Payment Integrity Contact Center Account Management Technology and Analytics to improve handoffs reduce avoidable escalations and address recurring root causes.
• Oversee root-cause remediation by analyzing escalated issue trends prioritizing fixes based on provider impact and enterprise ROI and driving cross-functional follow-through on the highest-value operational improvements.
• Establish closed-loop tracking to ensure identified root causes are addressed operational fixes are adopted and improvements reduce recurring provider friction across strategic accounts and the broader provider network.
• Create executive-ready reporting on provider issue trends operational health risks blockers and decisions needed.
• Serve as a senior escalation leader for urgent complex or high-profile provider issues.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 12 years of experience in healthcare operations provider operations payer operations claims operations network operations provider relations or a related field.
• 7 years of senior leadership experience including experience leading managers or multi-team operational functions.
• Experience leading complex issue resolution escalation management operational transformation or service model design in a healthcare environment.
• Strong understanding of payer operations including claims provider data network operations reimbursement utilization management payment integrity and provider service workflows.
• Proven ability to build operating models governance routines performance metrics and accountability mechanisms across multiple teams.
• Experience leading change management and adoption for new operating models across cross-functional teams.
• Strong analytical executive communication and stakeholder management skills.
• Comfort operating in ambiguity and building new functions teams and processes.
• Ability to quickly understand and operate within new technical systems and workflows.

Bonus points:

• Experience standing up or transforming provider service escalation claims resolution issue management or operational governance functions.
• Experience supporting strategic provider relationships large health systems or high-profile provider escalations.
• Experience with Jira Salesforce ServiceNow Zendesk or similar workflow management tools.
• Experience building dashboards SLA reporting operational performance reporting or issue-resolution analytics.
• Advanced Excel SQL or data analysis experience.

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. Were 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 applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () 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 .