Senior Director, Escalated Provider Issues & Resolution

Oscar Health; New York (NY); Hybrid; USD 218,592 - 286,902; Full time

Benefits offered by this job

Unlimited vacation

Equity grants

Annual performance bonuses

Job summary

Oscar Health in New York is seeking a Senior Director to lead escalated provider issue resolution within the Network & Provider Management team. You will guide a multi-disciplinary group, set operating standards, and partner across Claims, Network, Utilization Management, and Analytics to reduce escalations and drive improvements.

The role reports to the SVP, Network & Provider Management, and is based in NYC with a hybrid schedule.

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.

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

Job description

Oscar Health in New York is seeking a Senior Director to lead escalated provider issue resolution within the Network & Provider Management team. You will guide a multi-disciplinary group, set operating standards, and partner across Claims, Network, Utilization Management, and Analytics to reduce escalations and drive improvements.

The role reports to the SVP, Network & Provider Management, and is based in NYC with a hybrid schedule.