Senior Director, Escalated Provider Issue Resolution

Oscar Health; Phoenix (AZ); Hybrid; USD 196,732 - 258,211; Full time

Job summary

Oscar Health is seeking a Senior Director, Escalated Provider Issue Resolution to lead a multi-disciplinary team in the Network & Provider Management group. The role emphasizes strategic provider support, high-complexity escalations, root-cause remediation, and governance of provider services.

You will build a scalable operating model for escalated issues, coordinate with Claims, Network, Utilization Management, Payment Integrity, and Analytics, and report to the SVP.

Qualifications

• 12+ years of experience in healthcare operations, provider operations, payer operations, claims operations, network operations, provider relations, or a related field.
• 7+ years of senior leadership experience, including experience leading managers or multi-team operational functions.
• Experience leading complex issue resolution, escalation management, operational transformation, or service model design in a healthcare environment.
• Strong understanding of payer operations, including claims, provider data, network operations, reimbursement, utilization management, payment integrity, and provider service workflows.
• Proven ability to build operating models, governance routines, performance metrics, and accountability mechanisms 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.
• Ability to quickly understand and operate within new technical systems and workflows.

Responsibilities

• Lead and develop a multi-disciplinary provider issue resolution organization, including teams focused on strategic provider support, complex issue resolution, root-cause remediation, and provider service governance.
• Build a scalable operating model for escalated provider issues, including intake standards, triage criteria, escalation pathways, ownership expectations, service metrics, and closure practices.
• Oversee resolution of high-impact provider issues that require coordination across multiple operational teams.
• Partner with leaders across Claims, Network, Utilization Management, Payment Integrity, Contact Center, Account Management, Technology, and Analytics to improve handoffs, reduce avoidable escalations, and address recurring root causes.
• Oversee root-cause remediation by analyzing escalated issue trends, prioritizing fixes based on provider impact and enterprise ROI, and driving cross-functional follow-through on the highest-value operational improvements.
• Establish closed-loop tracking to ensure identified root causes are addressed, operational fixes are adopted, and improvements reduce recurring provider friction across strategic accounts and the broader provider network.
• Create executive-ready reporting on provider issue trends, operational health, risks, blockers, and decisions needed.
• Serve as a senior escalation leader for urgent, complex, or high-profile provider issues.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Skills

Leadership

Healthcare operations

Escalation management

Strategic thinking

Stakeholder management

Data analysis

Executive communication

Change management

Tools

Jira

Salesforce

ServiceNow

Zendesk

Excel

SQL

Job description

Hi, we're Oscar. We're hiring a Senior Director, Escalated Provider Issue Resolution to join our Network & Provider Management 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 Senior Director, Escalated Provider Issue Resolution team supports strategic provider accounts, high-complexity escalations, root-cause remediation, and provider service governance. This role will build and scale the operating model for escalated provider issue resolution, lead a multi-disciplinary team, and partner across Claims, Network, Utilization Management, Payment Integrity, Contact Center, Account Management, Technology, Analytics, and senior leadership to improve how Oscar identifies, routes, resolves, and prevents provider issues. This position will report to the SVP, Network and Provider Management.

You will report into the SVP, Network & Provider Management

Work Location

This position is based in our Tempe, Arizona 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.

Pay Transparency

The base pay for this role is: $196,732 - $258,211 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities

• Lead and develop a multi-disciplinary provider issue resolution organization, including teams focused on strategic provider support, complex issue resolution, root-cause remediation, and provider service governance.
• Build a scalable operating model for escalated provider issues, including intake standards, triage criteria, escalation pathways, ownership expectations, service metrics, and closure practices.
• Oversee resolution of high-impact provider issues that require coordination across multiple operational teams.
• Partner with leaders across Claims, Network, Utilization Management, Payment Integrity, Contact Center, Account Management, Technology, and Analytics to improve handoffs, reduce avoidable escalations, and address recurring root causes.
• Oversee root-cause remediation by analyzing escalated issue trends, prioritizing fixes based on provider impact and enterprise ROI, and driving cross-functional follow-through on the highest-value operational improvements.
• Establish closed-loop tracking to ensure identified root causes are addressed, operational fixes are adopted, and improvements reduce recurring provider friction across strategic accounts and the broader provider network.
• Create executive-ready reporting on provider issue trends, operational health, risks, blockers, and decisions needed.
• Serve as a senior escalation leader for urgent, complex, or high-profile provider issues.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements

• 12+ years of experience in healthcare operations, provider operations, payer operations, claims operations, network operations, provider relations, or a related field.
• 7+ years of senior leadership experience, including experience leading managers or multi-team operational functions.
• Experience leading complex issue resolution, escalation management, operational transformation, or service model design in a healthcare environment.
• Strong understanding of payer operations, including claims, provider data, network operations, reimbursement, utilization management, payment integrity, and provider service workflows.
• Proven ability to build operating models, governance routines, performance metrics, and accountability mechanisms 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.
• Ability to quickly understand and operate within new technical systems and workflows.

Bonus Points

• Experience standing up or transforming provider service, escalation, claims resolution, issue management, or operational governance functions.
• Experience supporting strategic provider relationships, large health systems, or high‑profile provider escalations.
• Experience with Jira, Salesforce, ServiceNow, Zendesk, or similar workflow management tools.
• Experience building dashboards, SLA reporting, operational performance reporting, or issue‑resolution analytics.
• Advanced Excel, SQL, or data analysis experience.

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.