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The Physician Reviewer in Utilization Management will assess the medical appropriateness of services, perform clinical reviews based on evidence-based criteria, document decisions clearly, and ensure compliance with regulations. The role involves timely peer-to-peer discussions with providers and handling escalated reviews, while maintaining high-quality standards.
The Operations Associate will design and optimize processes for configuring Oscar's claims adjudication platform, focusing on technology and automation. Responsibilities include data analysis, solution implementation, risk identification, and cross-functional collaboration to enhance efficiency and effectiveness.
The Senior Specialist, Medical Coding Auditor supports the assessment of fraud, waste, and abuse in healthcare by auditing claims and coordinating activities to reduce FWA. Responsibilities include documenting findings, creating reports, training team members, and ensuring compliance with regulations.
The Manager, Member & Provider Compliance will ensure operational compliance and integrity, oversee the development and improvement of policies and procedures, represent the operations team during audits, and collaborate across departments for continuous improvement of compliance systems.
The Vice President of Network Operations oversees the provider network strategy, ensuring data quality, operational efficiency, and compliance. This role leads teams dedicated to provider data management, network monitoring, and performance management, while leveraging analytics for data-driven decisions and collaborating with stakeholders to align network performance with organizational goals.
The Associate Director, Member Experience Strategy will lead the strategy and implementation of member experience initiatives at Oscar. This role involves identifying cost-saving opportunities, managing budget processes, evaluating performance metrics, and developing direct reports, while ensuring compliance with regulations.
The Manager, Business Operations & Strategy at Oscar will lead cross-functional implementations and projects, manage stakeholder engagement, evaluate departmental performance through data analysis, and develop risk mitigation strategies. This role requires strong communication and project management skills to ensure successful change management and oversee team members' development.
The Senior Software Engineer II, Payment Integrity will develop and scale a claims system, leveraging machine learning to identify fraud and optimize data processing. This role involves collaboration with senior leaders and mentoring other engineers while executing complex technical projects that shape the healthcare company's strategy.
Join Oscar as an Operations, Data Analyst to analyze data, create operational dashboards, and collaborate across the organization to identify and remove inefficiencies. This role aims to deliver more affordable and higher-quality health care for Oscar's members.
The Associate, Operations Analytics will generate insights for the Operations Intelligence team, support business units in analyzing key financial metrics, and enhance operational dashboards. The role requires collaboration with stakeholders and the ability to present findings in a clear manner to drive data-driven decisions.
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