Senior Director, Escalated Provider Resolution & Strategy

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

Benefits offered by this job

Unlimited vacation

Equity grants

Annual performance bonuses

Medical, dental, and vision benefits

Job summary

Oscar Health in Tempe, AZ is seeking a Senior Director, Escalated Provider Issue Resolution to lead a multi-disciplinary team within Network & Provider Management. This executive role builds scalable operating models for escalated provider issues and partners across claims, network, utilization management, and analytics, reporting to the SVP.

Hybrid schedule with 3 days in-office. Base pay ranges from $196,732 to $258,211 per year plus benefits, equity grants, unlimited vacation, and annual

Qualifications

• 12+ years of experience in healthcare operations, provider operations, payer operations, claims operations, network operations, or related fields.
• 7+ years in senior leadership, including leading managers or multi-team functions.
• Experience leading complex issue resolution, escalation management, or service model design in healthcare.
• Strong understanding of payer operations: claims, provider data, network operations, reimbursement, utilization, and provider workflows.
• Ability to build operating models, governance, metrics, and accountability across teams.
• Experience leading change management across cross-functional teams.
• Strong analytical and executive communication skills.
• Comfort operating in ambiguity and building new functions and processes.

Responsibilities

• Lead and develop a multi-disciplinary provider issue resolution organization with teams for strategic provider support, complex issue resolution, root-cause remediation, and governance.
• Build a scalable operating model for escalated provider issues with intake standards, triage, escalation paths, ownership, metrics, and closure practices.
• Oversee resolution of high-impact provider issues requiring coordination across multiple teams.
• Partner with 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 trends, prioritizing fixes by provider impact and ROI, and driving cross-functional follow-through.
• Establish closed-loop tracking to ensure root causes are addressed and improvements reduce provider friction.
• Create executive-ready reporting on provider issue trends, health, risks, and blockers.
• Serve as a senior escalation leader for urgent, complex provider issues.
• Ensure compliance with all applicable laws and regulations.
• Other duties as assigned.

Skills

Leadership

Healthcare operations

Escalation management

Stakeholder management

Analytical skills

Change management

Executive communication

Cross-functional leadership

Tools

Jira

Salesforce

ServiceNow

Zendesk

Excel

SQL

Job description

Oscar Health in Tempe, AZ is seeking a Senior Director, Escalated Provider Issue Resolution to lead a multi-disciplinary team within Network & Provider Management. This executive role builds scalable operating models for escalated provider issues and partners across claims, network, utilization management, and analytics, reporting to the SVP.

Hybrid schedule with 3 days in-office. Base pay ranges from $196,732 to $258,211 per year plus benefits, equity grants, unlimited vacation, and annual