Teams at Oscar Health

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.