Associate Manager, Credentialing Operations

Oscar Health; United States; Remote; USD 65,000 - 94,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

11 paid holidays

Paid sick time

Paid parental leave

401(k) plan participation

Life and disability insurance

Paid wellness time and reimbursements

Job summary

Oscar Health is seeking an Associate Manager, Credentialing Operations to lead a credentialing team and ensure timely provider credentialing and re-credentialing. You will manage production, quality, SLAs, and escalations while driving process improvements and risk mitigation.

The role reports to the Senior Manager, Provider Operations Credentialing and is fully remote for U.S. residents (excluding several states).

Qualifications

• 3+ years of direct people management experience.
• 2+ years of experience in provider credentialing, re-credentialing, provider enrollment, or a closely related function.
• 3+ years of healthcare operations experience supporting high-volume production teams.
• 1+ year experience using data to drive decision making and continuous improvement.
• Strong proficiency navigating Excel/Google Sheets, JIRA, and/or SQL.
• Working knowledge of credentialing standards and requirements, including NCQA, CMS, state, and delegated-credentialing requirements.
• Experience supporting process improvement initiatives cross-functionally.
• Bachelor’s Degree.
• Experience leading credentialing operations for a health plan, health system, provider organization, or credentials verification organization.
• Prior healthcare or insurance-related experience.

Responsibilities

• Evaluates overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies
• Lead the day-to-day credentialing operation, including workload planning, queue management, service-level performance, quality, and issue resolution
• Collaboratively works with all relevant internal and external stakeholder groups to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives
• Conduct root-cause analysis on systemic issues and construct action plans to address
• Maintains, analyzes, and communicates reporting on assigned team KPIs. Track monthly and quarterly to meet departmental objectives
• Hire and manage a team of Oscar colleagues with direct responsibility for performance management, their growth and development, and associated HR administrative tasks
• Compliance with all applicable laws and regulations
• Other duties as assigned

Skills

People management

Credentialing

Healthcare operations

Data-driven decision making

Excel/Google Sheets

JIRA

SQL

NCQA knowledge

Cross-functional collaboration

Bachelor’s Degree

Healthcare/insurance experience

Education

Bachelor’s Degree

Tools

JIRA

SQL

Excel/Google Sheets

Job description

Associate Manager, Credentialing Operations

Remote

Hi, we're Oscar. We're hiring an Associate Manager, Credentialing Operations to join our Credentialing 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:

The Associate Manager, Credentialing Operations leads a team responsible for accurate and timely provider credentialing and re-credentialing. This role oversees production, quality, service levels, and escalations and ensures compliance with applicable regulatory, accreditation, contractual, and internal requirements. The Associate Manager uses performance data and cross-functional partnerships to improve workflows, mitigate risk, strengthen provider experience, and maintain network readiness.

You will report into the Senior Manager, Provider Operations Credentialing.

Work Location: This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories. Daily work is completed from your home office, with occasional travel required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $72,036 - $94,547 per year. The base pay for this role in all other locations is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Evaluates overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies
• Lead the day-to-day credentialing operation, including workload planning, queue management, service-level performance, quality, and issue resolution
• Collaboratively works with all relevant internal and external stakeholder groups to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives
• Conduct root-cause analysis on systemic issues and construct action plans to address
• Maintains, analyzes, and communicates reporting on assigned team KPIs. Track monthly and quarterly to meet departmental objectives
• Hire and manage a team of Oscar colleagues with direct responsibility for performance management, their growth and development, and associated HR administrative tasks
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 3+ years of direct people management experience
• 2+ years of experience in provider credentialing, re-credentialing, provider enrollment, or a closely related function
• 3+ years of healthcare operations experience supporting high-volume production teams
• 1+ year experience using data to drive decision making and continuous improvement
• Strong proficiency navigating Excel/Google Sheets, JIRA, and/or SQL
• Working knowledge of credentialing standards and requirements, including NCQA, CMS, state, and delegated-credentialing requirements
• Experience supporting process improvement initiatives cross-functionally
• Bachelor’s Degree
• Experience leading credentialing operations for a health plan, health system, provider organization, or credentials verification organization
• Prior healthcare or insurance-related experience

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.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.