Remote: Head of Escalations & Provider Issue Resolution

Oscar Health; United States; Remote; USD 197,000 - 258,000; Full time

Job summary

Oscar Health is hiring a Senior Director, Escalated Provider Issue Resolution to lead a multi-disciplinary team within Network & Provider Management. You will scale the operating model for escalated issues, drive root-cause remediation, and partner across Claims, Network, Utilization Management, and Technology to improve resolutions.

This is a fully remote role open to candidates in the United States, with potential future hybrid arrangements.

Qualifications

• 12+ years in healthcare operations or related field.
• 7+ years senior leadership experience (managing managers or multi-team functions).
• Experience leading complex issue resolution, escalation management, or service model design in healthcare.
• Strong understanding of payer operations (claims, provider data, network operations, reimbursement, utilization management, payment integrity).
• Proven ability to build operating models, governance routines, and accountability across multiple teams.
• Experience leading change management and adoption for new operating models across cross-functional teams.
• Strong analytical, executive communication, and stakeholder management skills.
• Comfort operating in ambiguity and building new functions, teams, and processes.

Responsibilities

• Lead and develop a multi-disciplinary provider issue resolution organization.
• Build a scalable operating model for escalated provider issues, including intake standards and escalation pathways.
• Oversee resolution of high-impact provider issues requiring cross-team coordination.
• Partner with leaders across Claims, Network, Utilization Management, Payment Integrity, Contact Center, Account Management, Technology, and Analytics.
• Oversee root-cause remediation by analyzing trends and prioritizing fixes based on ROI.
• Establish closed-loop tracking to ensure fixes are adopted and recurring friction is reduced.
• Create executive-ready reporting on provider issue trends, health, risks and blockers.
• Serve as a senior escalation leader for urgent or high-profile issues.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Skills

Senior leadership

Escalated issue resolution

Provider operations

Stakeholder management

Analytical skills

Tools

Jira

Salesforce

ServiceNow

Zendesk

Job description

Oscar Health is hiring a Senior Director, Escalated Provider Issue Resolution to lead a multi-disciplinary team within Network & Provider Management. You will scale the operating model for escalated issues, drive root-cause remediation, and partner across Claims, Network, Utilization Management, and Technology to improve resolutions.

This is a fully remote role open to candidates in the United States, with potential future hybrid arrangements.