Senior Director, Escalated Provider Issues & Strategy

Oscar Health; Dallas (TX); Remote; USD 197.000 - 258.000; Vollzeit

Benefits dieser Stelle

Medical, dental, and vision benefits

401(k) plan participation

Unlimited vacation program

Zusammenfassung

Oscar Health is hiring a Senior Director, Escalated Provider Issue Resolution to build and scale the operating model for escalated provider issues. You will lead a multi-disciplinary team and partner across Claims, Network, Utilization Management, and other functions to improve resolution and prevent recurrence.

The role reports to the SVP, Network and Provider Management and ultimately to the Vice President of Provider Integration & Experience.

Qualifikationen

• 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.

Aufgaben

• Lead and develop a multi-disciplinary provider issue resolution organization.
• Build a scalable operating model for escalated provider issues with intake standards, triage criteria, escalation pathways, ownership, metrics and closure practices.
• 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 to improve handoffs and reduce escalations.
• Oversee root-cause remediation by analyzing escalated issue trends and driving cross-functional improvements.
• Establish closed-loop tracking to ensure root causes are addressed and improvements reduce friction across accounts.
• Create executive-ready reporting on provider issue trends, operational health, risks, blockers, and decisions needed.
• Serve as a senior escalation leader for urgent or high-profile provider issues.

Kenntnisse

Leadership

Stakeholder management

Analytical thinking

Executive communication

Change management

Ambiguity tolerance

Technical systems fluency

Tools

Jira

Salesforce

ServiceNow

Zendesk

Jobbeschreibung

Oscar Health is hiring a Senior Director, Escalated Provider Issue Resolution to build and scale the operating model for escalated provider issues. You will lead a multi-disciplinary team and partner across Claims, Network, Utilization Management, and other functions to improve resolution and prevent recurrence.

The role reports to the SVP, Network and Provider Management and ultimately to the Vice President of Provider Integration & Experience.