Jobs at Oscar Health

• Decipher key business insights and trends, utilizing those insights to better position the business culturally and operationally
• Create routines that surface opportunities and implement risk mitigation strategies and drive cross-functional collaboration.

• Serve as the data lead for Oscar's network and reimbursement design strategies from a financial modeling and analytic perspective
• Develop and manage the roadmap for network analytics roadmap, capturing the range of network and contracting strategies designed to optimize our network

• Manage leaders’ calendars by developing a thorough understanding of cross-departmental objectives and prioritizations.
• Support travel and expense management for department leaders.

• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Utilize data analysis skills and tools to develop accurate, quantitative analyses of issues.

• Manage queue work and and assigned caseload through efficient dashboard management
• Identify, investigate, and resolve issues within determined SLAs

• Provide medical care virtually (both by phone and message) in alignment with Oscar Medical Group guidelines, practices and policies
• Provide direct oversight and supervision of nurse practitioners and physician assistants within state by state regulations

• Design and implement new campaign development processes while anticipating potential future use cases to ensure long-term scalability in solution design.
• Become an expert in our client and campaign data, leveraging SQL to identify trends in client populations to deliver campaigns that drive value to their business.

• Be accountable for the end-to-end process for development and review of pharmacy and medical drug guidelines and lead a team of contracted and/or matrixed reports to ensure timely review and submission of guideline updates in close partnership with our Pharmacy Operations team.
• Take the lead in drafting, obtaining approval, and maintaining pharmaceutical and medical drug ...

• Shape the vision / strategy for the BPO Strategy & Governance team specifically around operationally sound principles and guidelines
• Adept in data analysis and reporting capabilities with an understanding of being able to sort through complex problems and initiatives

• Serve as the data lead for one of Oscar’s medium-sized ACA markets, analyzing cost and utilization trends to identify key drivers and uncover root causes of emerging developments
• Build, maintain, and enhance KPI frameworks to closely monitor financial performance, proactively detecting emerging signals or deviations from expected results

• Budgeting & Forecasting:

Support members of Insurance Leadership team across Insurance function (Medical, Network, Contracting, Growth) to enable the effective execution of the annual and multi-year operating plan.
Provide valuable insights of performance on an ongoing basis to leadership.

• Support members of Insurance Leadership team across Insurance function (Medical, Network, Contr...

• Provide live video virtual check in and check out support for patients
• Provide live phone and messaging support for patients

• Manage patients’ healthcare needs through traditional phone calls, video calls, and asynchronous messaging
• Maintain quality standards on all documentation and communications using the appropriate platforms.

• Support research, tracking, and intake in Gov/Regulatory Affairs (i.e.Regulatory Complaints)
• Coordinate case assignment

• Manage a panel of patients with mild to moderate behavioral health conditions in close collaboration with the primary care provider (200-250 per month for 1.0 FTE = 40 hrs / week)
• Provide brief interventions using evidence-based techniques such as Behavioral Activation, Problem-Solving Treatment, Motivational Interviewing, or other treatments appropriate for primary care settings.

• Design, implement and lead cross-functional strategy for key delegate vendor partners providing core benefit offerings including Prescription Benefit, Behavioral Health and Transplant
• Select and manage strategic vendor partners ensuring that we have a clinically effective and cost-effective program.

• Assist members in following an outcome-based plan of care, based on the member's input and assessment results and identify/address current needs of the member, using outlined escalation pathways when needed.
• Outreach identified members to identify and help solve for barriers that may affect their care ...

• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Utilize data analysis skills and tools to develop accurate, quantitative analyses of claims issues.

• Review core pricing and plan design models and provide actuarial insights that will inform strategic pricing considerations.
• Main contributor in reviewing and submitting regulatory filings.

• Building and managing broker and GA (General Agent) relationships in the assigned geographic market and as required to support growth goals
• Identifying distribution partners to invest in and building relationships over time