Senior Director, Escalated Provider Issues & Resolution

name; Tempe (AZ); Hybrid; USD 196,732 - 258,211; Full time

Job summary

Oscar is seeking a Senior Director, Escalated Provider Issue Resolution to lead a multi-disciplinary team within Network & Provider Management in Tempe. The role focuses on strategic provider accounts, high-complexity escalations, root-cause remediation, and governance across multiple functions.

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

Qualifications

• 12+ years in healthcare operations, provider operations, payer operations, or related fields.
• 7+ years in senior leadership, managing managers or multi-team functions.
• Experience leading complex issue resolution and transformation in healthcare.
• Strong understanding of payer operations including claims and utilization management.
• Ability to build operating models, governance, metrics, and accountability.
• Experience with change management across cross-functional teams.

Responsibilities

• Lead a multi-disciplinary provider issue resolution organization across strategic support, complex resolution, and governance.
• Build a scalable operating model for escalated issues with intake standards, triage, escalation paths, and service metrics.
• Oversee resolution of high-impact issues requiring cross-team coordination.
• Partner with Claims, Network, Utilization Management, Payment Integrity, and other functions to improve handoffs and reduce escalations.
• Drive root-cause remediation and track fixes with enterprise ROI and follow-through.
• Establish closed-loop tracking to ensure improvements are adopted and friction reduced.
• Create executive-ready reporting on provider issue trends, health, risks, and decisions.
• Serve as a senior escalation leader for urgent, complex, or high-profile issues.
• Comply with all applicable laws and regulations.

Skills

Healthcare operations

Escalation management

Cross-functional leadership

Analytical thinking

Executive communication

Change management

Tools

Jira

Salesforce

ServiceNow

Zendesk

Excel

Job description

Oscar is seeking a Senior Director, Escalated Provider Issue Resolution to lead a multi-disciplinary team within Network & Provider Management in Tempe. The role focuses on strategic provider accounts, high-complexity escalations, root-cause remediation, and governance across multiple functions.

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