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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. You will be responsible for translating complex business requirements into automated logic and business rules that ensure seamless authorization processing. As a subject matter expert, you will serve as the primary point of contact for the UM system, educating cross-functional partners (Product, Clinical, Regulatory) on how system configuration impacts operations and supports organizational needs.
Key responsibilities include managing configuration and maintenance of authorization workflows, rulesets, and automations within the UM platform; translating business requirements into precise technical specifications; investigating and resolving escalations through root cause analysis; identifying friction points in the authorization process and documenting improvement opportunities; developing and implementing testing protocols to validate system behavior; and maintaining comprehensive documentation of business rules, technical specifications, and workflow designs. You will also manage assigned caseloads and project tasks through dashboard management and prioritization, and handle internal escalations to identify causes and remediation pathways.
This role reports to the Associate Director, UM Optimization. You will be fully remote, though the company notes that future work models could potentially involve hybrid presence at a 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
