Sr. Analyst, Authorization Services Design & Configuration

Oscar Health; New York (NY); Remote; USD 68,000 - 89,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonuses

Job summary

Oscar Health is seeking a Sr. Analyst for Authorization Services Design & Configuration. This role focuses on designing the workflows and business rules within our Utilization Management (UM) system to ensure seamless authorization processing.

You will translate complex requirements into automated logic, handle escalations, and educate cross-functional partners on how configurations guide care decisions. This is a remote role with potential hybrid options in your metro area.

Qualifications

• 2+ years of system configuration or business rules management.
• 2+ years in a technical/operational role with root-cause analysis.
• Experience in Excel/Google Sheets with advanced features.
• Strong ability to translate business requirements into technical specifications.
• 1+ year in healthcare payer or provider industry.
• Prior work in Prior Authorizations or Insurance Operations.
• 2+ years in SQL, BigQuery, or similar.

Responsibilities

• Manage configuration and maintenance of authorization workflows and rulesets within the UM platform.
• Translate business requirements into precise technical specifications for implementation.
• Investigate escalations using root cause analysis to identify gaps.
• Identify friction points in the authorization process and propose automations.
• Act as SME for the UM system, educating cross-functional teams on configurations.
• Develop testing protocols and validate system behavior; lead corrective activities.
• Manage caseloads and tasks via dashboards and prioritization.
• Document all business rules, technical specs, and workflow designs.
• Handle other duties as assigned.

Skills

Excel/Google Sheets

SQL/BigQuery

Data troubleshooting

Communication skills

Healthcare domain knowledge

Process mapping

Tools

JIRA

Linear

Slack

Job description

Sr. Analyst, Authorization Services Design & Configuration

New York, New York, United States

Hi, we're Oscar. We're hiring a Sr. Analyst, Authorization Services Design & Configuration to join our team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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:

You will be the architect of our medical management operations. You will design the workflows and business rules within our Utilization Management (UM) system to ensure seamless authorization processing. You will translate complex requirements into automated logic. You will handle internal escalations to identify causes and remediation pathways. As a subject matter expert, you will act to educate cross-functional partners on how our systems guide care decisions.

We are looking for a systems thinker with a collaborative mindset who enjoys solving complex, systems level problems.

You will report into the Associate Director, UM Optimization.

Work Location:

This is a remote position, open to candidates who reside in: Dallas, TX. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency:

The base pay for this role is: $67,813 - $89,005 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Manage the configuration and maintenance of authorization workflows, rulesets, and automations within the UM platform.
• You will translate business requirements into precise technical specifications, ensuring that business rules and logic are accurately represented, tested, and implemented.
• Investigate and resolve escalations by performing root cause analysis on system behavior and configuration gaps.
• You will Identify "friction points" in the authorization process and document formal opportunities for workflow improvement and automation.
• Be the primary subject matter expert for the UM system, educating other teams (Product, Clinical, Regulatory) on how configuration impacts operations and supports our needs.
• Develop testing protocols and implement test scenarios to validate expected system behavior and configuration accuracy. Lead corrective activities when system behavior deviates from expectations.
• Manage assigned caseloads and project tasks through dashboard management and prioritization.
• Maintain clear, comprehensive documentation of all business rules, technical specs, and workflow designs.
• Other responsibilities as assigned.

Requirements:

• 2+ years of experience in system configuration, business rules management, or technical workflow design.
• 2+ years of experience in a technical/operational role involving root-cause analysis and data troubleshooting.
• Intermediate to Advanced proficiency in Excel/Google Sheets (vlookups, pivot tables, and data manipulation).
• Experience assessing and comprehending end-to-end process impacts in complex technical environments.
• Strong communication skills with the ability to explain technical system logic to non-technical partners.
• 1+ year working knowledge of within the healthcare industry (payer or provider).
• Prior work experience in Prior Authorizations or Insurance Operations.
• 2+ years of proficiency in SQL, BigQuery, or similar database languages.
• Experience using project management and communication tools like JIRA, Linear, and Slack.
• Experience working with large datasets, data verification, and data management.

This is an authentic Oscar Health job opportunity.

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.

Artificial Intelligence (AI):

Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

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.

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 Privacy Policy .

Oscar Health is authorized to do business in many, but not all, states. If you are not located in or willing to relocate to a state where Oscar is registered, you will not be eligible for employment. The approved states for this role are listed in the job posting.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Oscar Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

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