Oscar

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

Nurse Practitioner, Physician Assistant – Bilingual

Auditor

• Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts.
• Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data is supported within provider encounter documentation
• Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented.
• Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
• Conduct CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
• Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
• Identify and execute on the creation of clinical document improvement resources for provider education in both MA and ACA line of business.
• Manage the implementation process improvements that will maximize risk adjustment factor increases.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Auditor, Risk Adjustment

• Provide direct oversight and supervision of nurse practitioners and physician assistants within state by state regulations
• Provide medical care virtually (by phone, video, & message) in alignment with Oscar Medical Group guidelines, practices and policies
• Collaborate with MAs, RNs, and other providers across service lines
• Compliance with all applicable laws and regulations
• Other duties as assigned

Bilingual Physician – Virtual Health Assessment

Manager

• Develop and advance market-level strategies that improve growth, retention, performance improvement, and expansion across Oscar's product portfolio
• Partner closely with insurance product peers, finance, actuarial, network, clinical, sales, and market leadership to assess market dynamics
• Translate complex data and market intelligence into clear recommendations that support executive decision-making
• Lead strategic analyses and cross-functional programs related to market expansion, portfolio optimization, and segment specific growth opportunities

Senior Manager, Market Strategy Advisory

Insurance

• Conduct primary and secondary market research to support insurance product strategy and market-level decision-making
• Analyze healthcare market trends, consumer behaviors, competitor activity, and product performance
• Develop market research summaries, dashboards, presentations, and strategic insights for company partners
• Support competitive intelligence through data gathering and analysis
• Help develop market analyses, consumer segmentation, and opportunity assessments
• Partner with team members to support research requests and strategic programs
• Compile and maintain market intelligence databases, reports, and recurring deliverables
• Translate complex data into concise, relevant insights for business audiences
• Support qualitative and quantitative research projects, including surveys, interviews, and market assessments
• Contribute to continuous improvement of research methodologies and reporting processes
• Compliance with all applicable laws and regulations
• Other duties as assigned

Manager, Insurance Product Market Research

• Monitor competitor product strategies, benefits, network positioning, and market activity
• Develop competitor profiles, market summaries, strategic insights, and executive ready presentations
• Conduct market and competitive analysis using regulatory filings, enrollment data, financial reports, consumer insights, and industry research
• Support development of product and market recommendations tied to growth, retention, and portfolio optimization goals
• Partner with product, actuarial, network, clinical, sales, and market leadership teams to evaluate market opportunities, growth, and risks
• Produce recurring reporting and ad hoc analyses related to product positioning and market dynamics
• Identify emerging trends, disruptive market shifts, and new ideas across the healthcare landscape
• Support strategic planning programs and market-specific business case development
• Contribute to development of standardized product specific intelligence frameworks and processes
• Compliance with all applicable laws and regulations
• Other duties as assigned

Senior Manager, Insurance Product Intelligence

• Help develop insurance plan designs, including benefits, cost-sharing, and network structures
• Translate strategic direction and regulatory requirements into detailed, executable benefit configurations
• Ensure plan designs are reflected across internal systems and regulatory filings
• Partner with actuarial, regulatory, and compliance teams to validate benefit structures and cost-sharing agreement
• Support execution of the product lifecycle from design through filing, implementation, and launch readiness
• Maintain disciplined operating rhythms across design and filing cycles, ensuring timelines, dependencies, and deliverables are consistently met
• Improve process optimization and standardization across markets to improve scalability, reduce defects, and enhance speed to market
• Lead continuous improvement efforts across product design and filing workflows, identifying inefficiencies and implementing sustainable solutions
• Perform QA across plan designs, filings, and system configurations to ensure accuracy and compliance
• Identify and escalate inconsistencies or risks in design and execution
• Coordinate across partners to ensure accurate delivery of plans
• Support market, competitive, and regulatory analysis to inform plan design decisions
• Help monitor plan performance and identification of improvement opportunities post-launch
• Compliance with all applicable laws and regulations
• Other duties as assigned

Manager, Insurance Product and Benefit Design

• Own the development and evolution of the employer-subsidized product strategy, including target segments, value proposition, and market expansion roadmap in partnership with cross-functional stakeholders, including Growth, Sales, and ICHRA leadership
• Lead and contribute to business cases associated with new products, including return on investment assessments to propel growth in membership and profitability, alongside a positive brand experience
• Identify and assess new growth opportunities across employer-sponsored, individual, and adjacent product spaces
• Define market-specific right to win strategies, competitive positioning, and expansion priorities
• Translate enterprise and market-level strategies into relevant product programs and measurable outcomes
• Partner with peers to translate strategies into scalable, fileable product designs
• Ensure ICHRA and new solutions align with product architecture, benefit design standards, and member value propositions
• Promote consistency and reusability through modular product design, avoiding one-off or fragmented solutions
• Support development of competitive product offerings, informed by market insights, pricing considerations, and member insights
• Serve as primary connector across key stakeholders including actuarial, network, market leadership, compliance, regulatory affairs, corporate strategy, distribution and growth to drive alignment with competing priorities, ensuring timely decision making and execution orientation
• Establish measurements, including growth, retention, margin, and market competitiveness with corporate finance
• Support business case development and oversight of vendor and partner relationships related to new solutions, while ensuring operational processes are in place to mitigate risks
• Compliance with all applicable laws and regulations
• Other duties as assigned