Senior Director, Escalated Provider Resolution (Hybrid NYC)

Oscar Health; New York (NY); Hybrid; USD 219,000 - 287,000; Full time

Benefits offered by this job

Unlimited vacation

Equity grants

Annual performance bonuses

Job summary

Oscar Health is hiring a Senior Director, Escalated Provider Issue Resolution in New York City. Hybrid work requires 3 days in-office per week with Thursdays fixed for in-office meetings.

You will lead a multi-disciplinary team, govern provider issue resolution, and partner across Claims, Network, and Analytics to prevent recurring provider friction. Base pay ranges from $218,592 to $286,902, with benefits and equity opportunities.

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 with teams for strategic provider support, complex issue resolution, root-cause remediation, and provider service governance.
• Build a scalable operating model for escalated provider issues with 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 and reduce escalations.
• Oversee root-cause remediation by analyzing escalated issue trends and driving cross-functional follow-through on improvements.
• Establish closed-loop tracking to ensure root causes are addressed and improvements reduce recurring provider friction.
• 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.
• Ensure compliance with all applicable laws and regulations.
• Other duties as assigned

Skills

Leadership

Stakeholder Management

Analytical

Executive Communication

Change Management

Ambiguity Handling

Tools

Jira

Salesforce

ServiceNow

Zendesk

Job description

Oscar Health is hiring a Senior Director, Escalated Provider Issue Resolution in New York City. Hybrid work requires 3 days in-office per week with Thursdays fixed for in-office meetings.

You will lead a multi-disciplinary team, govern provider issue resolution, and partner across Claims, Network, and Analytics to prevent recurring provider friction. Base pay ranges from $218,592 to $286,902, with benefits and equity opportunities.