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Salary: USD 67,813 - 89,005 / annual
Oscar Health is seeking a Senior Analyst, Authorization Services Design & Configuration to architect and optimize medical management operations. In this role, you will design workflows and business rules within Oscar's Utilization Management (UM) system to ensure seamless authorization processing. You will translate complex business requirements into automated logic, investigate and resolve escalations through root cause analysis, and serve as the primary subject matter expert for the UM platform.
Key responsibilities include:
- Managing configuration and maintenance of authorization workflows, rulesets, and automations within the UM platform
- Translating business requirements into precise technical specifications and ensuring accurate implementation and testing
- Investigating escalations and performing root cause analysis on system behavior and configuration gaps
- Identifying friction points in the authorization process and documenting opportunities for workflow improvement and automation
- Serving as the primary SME for the UM system, educating Product, Clinical, and Regulatory teams on how configuration impacts operations
- Developing and implementing testing protocols to validate system behavior and configuration accuracy
- Managing assigned caseloads and project tasks through dashboard management and prioritization
- Maintaining comprehensive documentation of business rules, technical specifications, and workflow designs
You will report to the Associate Director, UM Optimization. This is a hybrid role based in Tempe, AZ, requiring 3 days of in-office work per week, with Thursdays as a mandatory in-office day for team meetings and events.
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, data manipulation)
- Experience assessing and comprehending end-to-end process impacts in complex technical environments
- Strong communication skills with ability to explain technical system logic to non-technical partners
- 1+ year of working knowledge within the healthcare industry (payer or provider side)
Bonus qualifications:
- Prior work experience in Prior Authorizations or Insurance Operations
- 2+ years of proficiency in SQL, BigQuery, or similar database languages
- Experience with project management and communication tools (JIRA, Linear, Slack)
- Experience working with large datasets, data verification, and data management
