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Director, Provider Operations

1 month, 1 week ago
United States
Full-time
Executive
Operations Manager
Project and Program Management
SQL
Apply Now
Oscar

Oscar

Oscar is a health insurance company that offers plans for individuals, families, and small businesses. With a focus on humanizing health care through technology, design, and data, Oscar provides easy-to-understand bills, 24/7 access to doctors, and a p...

Insurance
1K-5K
Founded 2012
View All Jobs 65

Description

  • Set the vision and strategy for provider operations and provider data functions.
  • Provide strategic leadership and operational oversight for the end-to-end provider data lifecycle.
  • Ensure accurate and timely execution of provider credentialing, contract loading, and daily data management.
  • Lead, coach, and develop a multi-tiered team of managers and individual contributors.
  • Establish organizational structure, governance, and support systems that enable the team to execute strategic initiatives.
  • Partner with Product, Tech, Markets, and Clinical Operations to design and deliver provider operations capabilities.
  • Architect and implement scalable processes and data models for provider data and contracting infrastructure.
  • Drive operational diagnostics, define KPIs, and build monitoring dashboards to identify bottlenecks and issues.
  • Identify and execute automation and process improvement opportunities to reduce manual work, turnaround time, and errors.
  • Ensure compliance with applicable state and federal laws, CMS requirements, and NCQA standards.

Requirements

  • Bachelor's degree or 5+ years of operating experience.
  • 10+ years of experience in operations, health insurance, data analysis, and/or consulting.
  • 5+ years of experience building, coaching, and developing operational teams.
  • 5+ years of experience with network operations, provider data management, and contracting processes.
  • 5+ years of experience developing and managing large-scale initiatives with internal and external stakeholders.
  • 5+ years of experience designing and improving business processes and related operating and technical procedures.
  • 5+ years of experience using data to influence business decisions.
  • 5+ years of experience in program management.
  • Experience pitching complex business cases to executive leadership is preferred.
  • Proficiency in SQL, Lean Six Sigma, or other process improvement methodologies is preferred.
  • Deep understanding of data architecture and data management workflows is preferred.
  • Comprehensive knowledge of NCQA credentialing, CMS standards, and the No Surprises Act is preferred.
  • Experience with enterprise-level MDM or Provider Data Management systems is preferred.
  • Experience applying AI, RPA, or data analytics to improve roster accuracy and processing speed is preferred.
  • Experience leading distributed teams and managing external BPO or vendor partnerships is preferred.

Benefits

  • Base salary of $147,549 to $193,658 per year.
  • Unlimited vacation program.
  • Company equity grants.
  • Annual performance bonuses.
  • Medical, dental, and vision insurance.
  • 11 paid holidays, paid sick time, paid parental leave, and paid wellness time.
  • 401(k) plan participation.
  • Life and disability insurance, plus wellness reimbursements.

Interested in this position?

Apply directly on the company website

Apply Now

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