Oscar

Customer Support

• Develop a comprehensive understanding of the current processes, procedures, and tools associated with the Oscar business model.
• Work with members, brokers, providers, and Oscar vendors through multiple channels according to assignment needs
• Manage an assigned caseload, maintaining service delivery, productivity, and quality expectations
• Form working relationships with all partners.
• Support the leadership team by identifying issues through established escalation pathways
• Monitor and track the health of all assigned work-in-progress issues.
• Escalate and resolve issues to ensure appropriate turnaround times
• Participate in process improvement projects
• Comply with all operational, regulatory, and compliance standards relating to member Personal Health Information (PHI)
• Compliance with all applicable laws and regulations
• Other duties as assigned

Part-Time Customer Service Representative

Customer Service Representative

Bilingual Customer Service Representative

Bilingual

• Perform preventative care screenings, complete medication reconciliation, diagnose medical conditions and provide health coaching, referrals and treatment when clinically appropriate.
• Outreach members who are more chronically ill based on historical and suspected health information.
• Engage members who have a lower probability of seeing their PCP.
• Identify areas in the member's medical journey that can be improved by increasing their access to care with a licensed provider.
• Cross-train into urgent care and/or virtual primary care service line
• Interact with members virtually, including virtual assessment, diagnosis and treatment.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Bilingual Physician Assistant – Virtual Health Assessment

Bilingual Nurse Practitioner – Virtual Health Assessment

• Provide medical care virtually (both by phone and message)
• Provide patient care in alignment with Oscar Medical Group guidelines, practices and policies
• Focus on efficiency and quality of care delivery
• Ensure patient access to VUC services
• Collaborate with MAs, RNs, and other providers across service lines (e.g. primary care and health assessments)

Bilingual NP/PA – Virtual Urgent Care

• Provide virtual based care to Oscar Health Insurance members within designated Oscar states
• Provide compassionate, evidence-based care to patients using audio, video, and written forms of communication
• Report into the Medical Director, Virtual Urgent Care
• Participate in collaborative care model with various care team members including but not limited to registered nurses, medical assistants, PCPs, behavioral health clinicians, and clinical supervisor where applicable
• Provide feedback to support improvement in operational workflows and product features
• Compliance with all applicable laws and regulations

Physician, Bilingual – Virtual Urgent Care

Claims Specialist

• Process incoming work associated with Claims operations following standard operating procedures.
• Report to the Claims Production Team Lead.
• Develop an excellent grasp of the Administrative Operations system and overall workflows.
• Develop a comprehensive understanding of the current review processes that exist and additional processes needed to improve consistency and quality of review.
• Contribute to the reduction of the daily inventory.
• Form relationships with all partners.
• Take ownership of monitoring, tracking, and providing a status on the health of all work-in-progress issues.
• Manage the escalation and resolution process with external vendors to ensure appropriate turnaround times (where applicable).
• Contribute to team-wide goals that support the success of Claims Productions daily operations.
• Compliance with all applicable laws and regulations.
• Other responsibilities as assigned.

Claims Processor

Network Engineer

• Support and direct involvement with negotiating contracts with assigned healthcare providers, focusing on favorable terms and compliance with organizational standards, strategy, and regulatory requirements.
• Conduct comprehensive reviews and analyses of assigned provider contracts, identifying areas for improvement and optimization.
• With support from your leader, utilize data and analytics of provider financial issues and competitor strategies to inform negotiation and contracting decisions.
• Support implementation of contracting policies and workflows; monitor and ensure effective and efficient contracting processes are in place.
• Monitor and analyze key metrics for network performance, cost, and provider satisfaction, and provide reports to leadership for assigned provider accounts.
• Ensure timely and professional resolution of provider issues Build and maintain positive relationships with healthcare providers to ensure network stability and quality.
• Assist in tracking and analyzing key performance indicators (KPIs) to monitor provider satisfaction and operational efficiency.
• Support provider onboarding, training, and resource distribution.
• Collaborate with internal teams such as Claims, Credentialing, and Contracting to resolve routine provider issues.
• Participate in process improvement initiatives to optimize workflows and enhance provider experience.
• Compliance with all applicable laws and regulations
• Other duties as assigned