Senior Specialist, Network Contracting Business Operations

Oscar Health Insurance; Mississippi; Remote; USD 77,000 - 91,000; Full time

Job summary

An innovative health insurance company is seeking a Senior Specialist in Network Contracting to enhance its Provider Network team. This role involves negotiating with healthcare providers, ensuring compliance with regulations, and utilizing data analytics to inform decisions. The ideal candidate will have experience in provider network operations and a passion for improving healthcare services. Join a dynamic team dedicated to transforming the health insurance landscape and making a meaningful impact on members' lives.

Benefits

Medical, dental, and vision benefits

401(k) plan participation

Paid parental leave

Paid sick time

Paid wellness time

11 paid holidays

Qualifications

• 2+ years in provider network operations or contracting.
• Experience in health insurance or healthcare industry.

Responsibilities

• Negotiate single case rates with out-of-network providers.
• Conduct reviews and analyses of provider contracts.
• Support implementation of contracting policies.

Skills

Negotiation

Data Analysis

Provider Relations

Contract Management

Education

Bachelor's Degree

Tools

Excel

Healthcare Software

Job description

Hi, we're Oscar. We're hiring a Senior Specialist, Network Contracting to join our Provider Network team.

Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

The Senior Specialist, Network Contracting, within the Independent Dispute Resolution (IDR) team intakes, processing, and negotiating post service single case agreements in the open negotiation period, ensuring claims are handled fairly, often under regulations like the No Surprises Act. This involves research, strategy, communication, and coordination of all IDR-related matters. The Senior Specialist may also play a role in recruiting new providers to the network, assisting with resolution of provider issues, and supporting cost-saving initiatives.

You will report to the Senior Director, Specialty Contracting. You will be Management Level 3.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $76,800 - $100,800 per year. The base pay for this role in all other locations is: $$77,760 - $90,720 per year. You are also eligible for employee benefits,monthly vacation accrual at a rate of 15 days per year and annual performance bonus.

Responsibilities

• Negotiate with Out-Of-Network (OON) providers/facilities to achieve favorable single case rates and avoid mediation/arbitration when possible.
• Support and direct involvement with negotiating contracts with assigned healthcare providers, focusing on favorable terms and compliance with organizational standards, strategy, and regulatory requirements.
• Conduct comprehensive reviews and analyses of assigned provider contracts, identifying areas for improvement and optimization.
• With support from your leader, utilizes data and analytics of provider financial issues and competitor strategies to inform negotiation and contracting decisions.
• Support implementation of contracting policies and workflows; monitors and ensure efficient contracting processes are in place.
• With input and support from their leader, monitor and analyze key metrics for network performance, cost, and provider satisfaction, and provide reports to leadership for assigned provider accounts.
• Ensure and professional resolution of provider issues Build and with healthcare providers to ensure network stability and quality.
• Help track and analyze key performance indicators (KPIs) to monitor provider satisfaction and operational efficiency.
• Support provider onboarding, training, and resource distribution..
• Collaborate with internal teams such as Claims, Credentialing, and Contracting to resolve routine provider issues.
• Participate in process improvement plans to optimize workflows and enhance provider experience.
• Compliance with all applicable laws and regulations
• Other duties as assigned.

Qualifications

• 2+ years of experience in provider network operations or contracting or provider services.
• 1+ years of experience in Health Insurance (Individual and/or Medicare Advantage) and/or Healthcare industry.
• 1+ years experience navigating and organizing large data sets such as claim files and provider rosters.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here .

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) to make the need for an accommodation known.

Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants .