Analyst, Risk Adjustment

Oscar Health, Inc.; New York (NY); Hybrid; USD 75,000 - 99,000; Full time

Job summary

Oscar Health, Inc. is seeking an Analyst, Risk Adjustment to join the Risk Adjustment team in a hybrid New York, NY office. The role focuses on Prospective Risk Adjustment program operations, data reporting, and vendor coordination to ensure accurate reviews and timely issue resolution.

You will support Point-of-Care tools, VHA/IHA programs, and provider reporting while partnering with internal teams and external vendors. This position reports to the Sr.

Qualifications

• Strong analytical and problem-solving skills.
• Strong attention to detail and organizational skills.
• Ability to work effectively with data, reporting tools, spreadsheets, and operational workflows.
• Strong written and verbal communication skills with cross-team collaboration.
• Knowledge of healthcare operations, Risk Adjustment, or health plan processes.
• Experience translating data findings into actionable steps.
• Proficiency with Excel or Google Sheets; familiarity with SQL, Tableau, Looker.
• Experience in health plan/provider/healthcare tech environments.
• Exposure to prospective Risk Adjustment programs and related workflows.

Responsibilities

• Prospective Risk Adjustment Program Operations (30%)—Support daily operations across prospective Risk Adjustment programs and monitor workflows.
• Vendor Operations & Support (25%)—Assist external vendors with data exchanges and issue resolution.
• Reporting, Data Analysis & Reconciliation (20%)—Develop recurring reports and validate data across sources.
• Point-of-Care & Provider Programs (15%)—Support tools and provider reporting initiatives.
• Member & Claims Operations (10%)—Review exclusions and reconcile claims for programs.

Skills

Analytical skills

Attention to detail

Communication

Excel

Google Sheets

SQL

Tableau

Looker

Healthcare knowledge

Vendor coordination

Education

Bachelor's degree

Tools

Excel

Tableau

Looker

SQL

Job description

Hi, we're Oscar. We're hiring a Analyst, Risk Adjustment to join our Risk Adjustment 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 ourselves—one that behaves like a doctor in the family.

About the role:

Risk Adjustment accounts for differences in members’ health needs and expected cost of care. Accurate and complete clinical documentation helps ensure that a member’s health status is appropriately represented. Prospective Risk Adjustment focuses on proactively supporting opportunities for healthcare providers to review members’ health information and accurately document conditions addressed during clinical care, in accordance with applicable clinical coding and documentation requirements. These efforts may include sharing relevant clinical information with providers at the point of care, conducting virtual or in-home health assessments, and providing reports that identify historical or suspected conditions for provider review and clinical validation.

The Analyst, Risk Adjustment supports the day-to-day execution and performance of Prospective Risk Adjustment programs. This role partners with internal teams and external vendors to ensure operational workflows are functioning as intended, program data and reporting are accurate, claims are processed appropriately, and operational issues are identified and resolved in a timely manner. The analyst will support a portfolio of initiatives including Point-of-Care tools, Virtual Health Assessments (VHA), In-Home Assessments (IHA), and provider reporting to support the review of member conditions. This role is well suited for an analytical, detail-oriented professional interested in developing expertise in Risk Adjustment and healthcare operations.

You will report into the Sr. Manager, Strategic Initiatives (Risk Adjustment).

Work Location:

This position is based in our New York, NY office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid

Pay Transparency:

The base pay for this role is: $75,348- $98,894 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Prospective Risk Adjustment Program Operations (30%) – Support daily operations across prospective Risk Adjustment programs, including Point-of-Care tooling, VHA, IHA, and provider gap-reporting initiatives. Monitor program activity and workflows to ensure processes are functioning as intended; investigate operational issues and coordinate resolution or escalation as appropriate.
• Vendor Operations & Support (25%) – Support the day-to-day operational needs of external vendors. Coordinate recurring deliverables and data exchanges, respond to operational questions, track issues and action items, and partner with vendors and internal stakeholders to drive timely resolution.
• Reporting, Data Analysis & Reconciliation (20%) – Develop and maintain recurring reports, trackers, and analyses to monitor program performance, including assessment activity, provider participation, vendor performance, claims activity, and other key operational metrics. Perform data validation and reconciliation across internal and vendor data sources to identify discrepancies, trends, and opportunities for operational improvement.
• Point-of-Care & Provider Programs (15%) – Support programs that provide relevant member health information, including historical and suspected conditions, to healthcare providers for review and clinical validation. Support Point-of-Care tools and provider reporting initiatives and assist with resolving related data, reporting, and workflow issues.
• Member & Claims Operations (10%) – Support member-level program operations, including reviewing and processing appropriate exclusions from VHA and IHA programs. Monitor and reconcile claims associated with prospective Risk Adjustment initiatives to ensure appropriate processing and payment; investigate discrepancies and partner with relevant teams to support resolution.

Requirements:

• Strong analytical and problem-solving skills, with the ability to investigate operational or data-related issues and support resolution.
• Strong attention to detail and organizational skills, with the ability to manage multiple priorities and recurring deliverables.
• Ability to work effectively with data, reporting tools, spreadsheets, and operational workflows.
• Strong written and verbal communication skills with the ability to collaborate effectively across teams and with external partners.
• Knowledge of healthcare operations, Risk Adjustment, claims, provider operations, or health plan processes.
• Experience analyzing data, identifying trends or discrepancies, and translating findings into actionable next steps.
• Proficiency with Excel or Google Sheets; familiarity with SQL, Tableau, Looker, or similar analytics tools is a plus.
• Experience within a health plan, provider organization, healthcare technology company, or other healthcare environment.
• Exposure to prospective Risk Adjustment programs, health assessments, Point-of-Care workflows, provider gap programs, healthcare claims, or vendor operations

Education:

• Bachelor’s degree in a healthcare, business, analytical, or related discipline preferred.

This is an authentic Oscar Health job opportunity.

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. We're 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 applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) 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 Privacy Policy .

Oscar Health is authorized to do business in many, but not all, states. If you are not located in or willing to relocate to a state where Oscar is registered, you will not be eligible for employment. The approved states for this role are listed in the job posting.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Oscar Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

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