Senior Director, Escalated Provider Resolution & Ops

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

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.