Oscar

Operations

• Serve as the primary operational link between OMG Clinical Leadership, HR, Finance, and Payroll to ensure provider-related business needs are met.
• Identify and implement process improvements across day-to-day people operations and administrative workstreams to reduce manual work and increase data accuracy for a multi-state clinical workforce.
• Analyze payroll and operational data to identify trends, reconcile discrepancies, and provide insights that influence budget and headcount planning.
• Manage the end-to-end integration of providers into HR and Payroll systems, ensuring that operational data flows seamlessly between platforms.
• Partner with HR Business Partners and Clinical Leads to triage and resolve complex operational inquiries, serving as a subject matter expert on OMG-specific pay structures.
• Ensure all provider operations maintain compliance with federal, state, and local regulations in a complex, multi-state healthcare environment.

Provider Operations Associate, Virtual Care

Compliance

• Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion
• Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies
• Collaboratively works with all relevant internal and external stakeholder groups to interpret and apply new and evolving regulations, ensuring consistent understanding and accurate implementation across UM operations.
• Coordinate regulatory request management for the UM department, including market conduct exams, URA filings, license renewals, and Mental Health Parity (MHPAEA) compliance.
• Coordinates NCQA deliverables for UM standards
• Evaluates and drafts UM policy and procedures ensuring compliance within the UM program
• Mentor team members and promotes colleagues' growth and professional development
• Compliance with all applicable laws and regulations
• Other duties as assigned

Associate, UM Regulatory Operations

• Support the design, optimization, and implementation of processes and improvements to operations in support of achieving organizational goals
• Responsible to support implementations for regulatory requirements, compliance initiatives, UM audits, and other projects
• Coordinate projects and processes to help support key regulatory and compliance milestones and deliverables
• Partner with leadership to implement regulations, support key state filings, and other projects
• Partner with cross-functional teams to ensure action plans and process improvements align with project goals, and participate in collaboration with peers and cross-functional stakeholders
• Support audit exams (NCQA, MHPAEA, State)
• Help identify risks; respond to and resolve compliance gaps through regulatory implementation and in response to audits and Corrective Action Plans
• Compliance with all applicable laws and regulations
• Other duties as assigned

Senior Analyst, UM Regulatory Operations

Data Analyst

• Responsible for owning insights generation and follow-up for a major business unit, serving as the first point of contact for Sr. Managers and Associate Directors
• Analyze data to support business teams in making better informed, data-driven decisions
• Use data to tell a story that non-technical colleagues will be able to understand, including packaging and presenting findings in a clear, concise and compelling manner
• Recognize the need to enhance essential operational and analytical dashboards, and define the requirements to enhance them as our user's needs evolve
• Identify opportunities to create models and tools that produce relevant insights to identify healthcare inefficiencies and generate insights to remove inefficiencies
• Collaborate across the organization, including owning stakeholder relationships with managers & senior managers, to identify actions to achieve improvements and monitor initiative impact
• Support other strategic projects as assigned to meet business needs
• Compliance with all applicable laws and regulations
• Other duties as assigned

Associate, Data Analytics

• Responsible for owning insights generation and follow-up for a major business unit, serving as the first point of contract for Sr. Managers and Associate Directors
• Analyze data to support business teams in making better informed, data-driven decisions
• Use data to tell a story that non-technical colleagues will be able to understand, including packaging and presenting findings in a clear, concise and compelling manner
• Recognize the need to enhance essential operational and analytical dashboards, and define the requirements to enhance them as our user's needs evolve
• Identify opportunities to create models and tools that produce relevant insights to identify healthcare inefficiencies and generate insights to remove inefficiencies
• Collaborate across the organization, including owning stakeholder relationships with managers & senior managers , to identify actions to achieve improvements and monitor initiative impact
• Support other strategic projects as assigned to meet business needs
• Compliance with all applicable laws and regulations
• Other duties as assigned

Analyst

• Manage the preparation and filing of Oscar's commercial insurance products through the annual filings for assigned states and regions, serving as an advisor to teams
• Develop processes for internal tracking and monitoring annual and ad hoc filings with diverse teams, including maintaining a repository of previously received objections to decrease YOY objection totals
• Build and support successful relationships with regulatory bodies, including state insurance regulators
• Be the subject matter expert on assigned states and contribute to the development of a repository of internal procedural guides on annual filing obligations to support teams and retain institutional knowledge
• Track and communicate filing objections received and guide overall resolution together with impacted teams
• Develop sustainable processes which simplify our growing team's outputs while ensuring high quality deliverables
• Compliance with all applicable laws and regulations

Senior Analyst, Licensing

Bilingual

• Provide live video virtual check in and check out support for patients
• Provide live phone and messaging support for patients
• Provide support for your Care Team, including virtual physicians, APPs and RNs
• Plan for each patient's medical needs from initial outreach, care coordination, to resolution
• Assist with the order process, including sending requisition forms and coordinating referrals
• Close the loop with providers after referrals are made, including collecting patient notes from providers
• Schedule appointments with patients for follow up care
• Call providers and facilities to clarify information and help solve complex cases
• Coordinate with internal and external parties to ensure patients needs are met (Laboratories, Imaging Facilities, Pharmacies, Vendors)
• Compliance with all applicable laws and regulations
• Other duties as assigned

Medical Assistant I, Bilingual – Spanish

• Analyze and summarize process behavior to expedite the design/solutioning process
• Translate configuration enabling internal teams to resolve escalations
• Process incoming Jira tickets to support provider escalation resolution
• Identify and pilot opportunities to improve operational efficiency
• Triage and manage workflows of ingested items
• Investigate escalations via incoming tickets or informal pathways
• Conduct necessary maintenance work and take on ad-hoc projects associated with in-network configuration.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Provider Operations Associate, Virtual Care

Associate, UM Regulatory Operations

Senior Analyst, UM Regulatory Operations

Associate, Data Analytics

Associate, Data Analytics

Associate, Data Analytics

Senior Analyst, Licensing

Medical Assistant I, Bilingual – Spanish

Senior Analyst, Configuration