Jobs at Oscar Health

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.

Support payment integrity disputes and issue resolution for claims. Scope, triage, investigate, and implement process improvements. Translate claim infrastructure and stakeholder friction into business requirements, collaborate cross-functionally, perform root cause analysis, and provide training and documentation to reduce adverse claim outcomes and improve reimbursement accuracy.

The Senior Director, Markets Strategic Advisory & Intelligence leads market strategy and analytics for product development, overseeing research, performance assessments, and strategic recommendations to support market expansion and optimize the product portfolio.

The Manager, Insurance Product Market Research conducts market research, analyzes health trends, and provides strategic insights to support product strategy and decisions.

The Associate Director oversees employer-subsidized product strategy, leading growth, market integration, and compliance across health insurance solutions.

Support ACA market pricing and plan design modeling, produce regulatory filings, provide actuarial guidance across cross-functional teams, maintain pricing models and documentation, and onboard analysts to ensure actuarially sound pricing.

The Senior Manager, Insurance Product Intelligence will lead intelligence programs, support strategic decision-making, and improve product performance through market insights and analysis.

Support ACA risk adjustment operations including medical record retrieval, provider outreach, inventory tracking, reporting, and process improvement. Monitor deliverables, assist management with decisions, ensure compliance, and collaborate with internal and external partners to meet CMS/HHS deadlines.

Own end-to-end health insurance plan and benefit design across assigned markets, translating strategy and regulatory requirements into compliant plan structures. Lead filings (PBT, SBC), optimize processes for scale, drive post-launch performance, partner cross-functionally with actuarial, regulatory, network and operations teams, mentor junior staff, and manage risk and QA to ensure timely, high-quality product launches.