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Salary: USD 196,732 - 258,211 / annual
Oscar Health, a technology-driven health insurance company founded in 2012, is seeking a Senior Director to lead and scale its Escalated Provider Issue Resolution function. This role sits within the Network & Provider Management organization and reports to the SVP of Network and Provider Management.
You will build and lead a multi-disciplinary team responsible for supporting strategic provider accounts, managing high-complexity escalations, driving root-cause remediation, and establishing provider service governance. Key responsibilities include designing a scalable operating model for escalated provider issues (intake standards, triage criteria, escalation pathways, service metrics), overseeing resolution of high-impact provider issues requiring cross-functional coordination, and partnering with Claims, Network, Utilization Management, Payment Integrity, Contact Center, Account Management, Technology, and Analytics teams to reduce avoidable escalations and address recurring root causes.
You will establish closed-loop tracking to ensure identified root causes are addressed and operational fixes are adopted across strategic accounts and the broader provider network. You'll create executive-ready reporting on provider issue trends, operational health, risks, and decisions needed, and serve as a senior escalation leader for urgent, complex, or high-profile provider issues.
Required qualifications include 12+ years in healthcare operations, provider operations, payer operations, claims operations, network operations, or provider relations; 7+ years of senior leadership experience leading managers or multi-team operational functions; and demonstrated experience leading complex issue resolution, escalation management, operational transformation, or service model design in healthcare. You must have a strong understanding of payer operations (claims, provider data, network operations, reimbursement, utilization management, payment integrity, provider service workflows), proven ability to build operating models and governance routines, and experience leading change management across cross-functional teams.
Bonus qualifications include experience standing up or transforming provider service, escalation, claims resolution, or operational governance functions; supporting strategic provider relationships or large health systems; experience with Jira, Salesforce, ServiceNow, Zendesk, or similar workflow tools; building dashboards and operational performance reporting; and advanced Excel, SQL, or data analysis skills.
The role is hybrid, based in Tempe, Arizona, requiring 3 days in-office per week with Thursdays mandatory for team meetings and events.
