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Senior Director, Escalated Provider Issue Resolution

5 days, 3 hours ago
United States
Full-time
Lead
Operations Manager
Customer and Technical Support
JIRA Salesforce SQL
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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

  • Lead and develop a multi-disciplinary provider issue resolution organization.
  • Build a scalable operating model for escalated provider issues, including intake, triage, escalation, ownership, metrics, and closure practices.
  • Oversee resolution of high-impact provider issues across multiple operational teams.
  • Partner with leaders across Claims, Network, Utilization Management, Payment Integrity, Contact Center, Account Management, Technology, and Analytics to improve issue handling and prevent recurring problems.
  • Oversee root-cause remediation by analyzing escalation trends, prioritizing fixes, and driving cross-functional follow-through.
  • Establish closed-loop tracking to ensure root causes are addressed and operational improvements reduce recurring provider friction.
  • Create executive-ready reporting on provider issue trends, risks, blockers, and decisions needed.
  • Serve as a senior escalation leader for urgent, complex, or high-profile provider issues.
  • Ensure compliance with all applicable laws and regulations.

Requirements

  • 12+ years of experience in healthcare operations, provider operations, payer operations, claims operations, network operations, provider relations, or a related field.
  • 7+ years of senior leadership experience, including leading managers or multi-team operational functions.
  • Experience leading complex issue resolution, escalation management, operational transformation, or service model design in a healthcare environment.
  • Strong understanding of payer operations, including claims, provider data, network operations, reimbursement, utilization management, payment integrity, and provider service workflows.
  • Proven ability to build operating models, governance routines, performance metrics, and accountability mechanisms across multiple teams.
  • Experience leading change management and adoption for new operating models across cross-functional teams.
  • Strong analytical, executive communication, and stakeholder management skills.
  • Comfort operating in ambiguity and building new functions, teams, and processes.
  • Ability to quickly understand and operate within new technical systems and workflows.
  • Experience standing up or transforming provider service, escalation, claims resolution, issue management, or operational governance functions (preferred).
  • Experience supporting strategic provider relationships, large health systems, or high-profile provider escalations (preferred).
  • Experience with Jira, Salesforce, ServiceNow, Zendesk, or similar workflow management tools (preferred).
  • Experience building dashboards, SLA reporting, operational performance reporting, or issue-resolution analytics (preferred).
  • Advanced Excel, SQL, or data analysis experience (preferred).

Benefits

  • Base salary of $196,732 to $258,211 per year.
  • Unlimited vacation program.
  • Company equity grants.
  • Annual performance bonuses.
  • Medical, dental, and vision benefits.
  • 11 paid holidays, paid sick time, and paid parental leave.
  • 401(k) plan participation.
  • Life and disability insurance.
  • Paid wellness time and reimbursements.

Interested in this position?

Apply directly on the company website

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