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Salary: USD 67,813 - 89,005 / annual
Oscar Health is seeking a Senior Analyst, Authorization Services Design & Configuration to architect medical management operations and design workflows within their Utilization Management (UM) system. In this role, you will be responsible for designing and maintaining authorization workflows, business rules, and automations that ensure seamless processing of medical authorizations. You will translate complex business requirements into precise technical specifications and automated logic, serving as the primary subject matter expert for the UM platform.
Key responsibilities include managing configuration and maintenance of authorization workflows and rulesets; translating business requirements into technical specifications with accurate testing and implementation; investigating and resolving escalations through root cause analysis; identifying friction points in authorization processes and documenting improvement opportunities; educating cross-functional partners (Product, Clinical, Regulatory) on how system configuration impacts operations; developing and implementing testing protocols to validate system behavior; managing assigned caseloads and project tasks; and maintaining comprehensive documentation of business rules and workflow designs.
You will report to the Associate Director of UM Optimization and work as part of a team focused on solving complex, systems-level problems in healthcare operations. This is a fully remote position open to candidates residing in Dallas, TX, though the company notes that future work models could potentially involve hybrid presence at the Dallas hub office.
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)
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
