Senior Director, Escalated Provider Issue Resolution
New
O
OscarHealth Insurance
Open to candidates who reside in: Dallas, Texas.Full-TimeDirector
Salary$196,732 - $258,211 per year
Apply NowOpens the employer's application page
Job Details
- Experience
- 12+ years of experience in healthcare operations, provider operations, payer operations, claims operations, network operations, provider relations, or a related field. 7+ years of senior leadership experience.
- Required Skills
- Data AnalysisStakeholder managementChange Management
Requirements
- 12+ years of experience in healthcare operations, provider operations, payer operations, claims operations, network operations, provider relations, or a related field.
- 7+ years of senior leadership experience, including experience leading managers or multi-team operational functions.
- Experience leading complex issue resolution, escalation management, operational transformation, or service model design in a healthcare environment.
- Strong understanding of payer operations, including claims, provider data, network operations, reimbursement, utilization management, payment integrity, and provider service workflows.
- Proven ability to build operating models, governance routines, performance metrics, and accountability mechanisms across multiple teams.
- Experience leading change management and adoption for new operating models across cross-functional teams.
- Strong analytical, executive communication, and stakeholder management skills.
- Comfort operating in ambiguity and building new functions, teams, and processes.
- Ability to quickly understand and operate within new technical systems and workflows.
Responsibilities
- Lead and develop a multi-disciplinary provider issue resolution organization, including teams focused on strategic provider support, complex issue resolution, root-cause remediation, and provider service governance.
- Build a scalable operating model for escalated provider issues, including intake standards, triage criteria, escalation pathways, ownership expectations, service metrics, and closure practices.
- Oversee resolution of high-impact provider issues that require coordination across multiple operational teams.
- Partner with leaders across Claims, Network, Utilization Management, Payment Integrity, Contact Center, Account Management, Technology, and Analytics to improve handoffs, reduce avoidable escalations, and address recurring root causes.
- Oversee root-cause remediation by analyzing escalated issue trends, prioritizing fixes based on provider impact and enterprise ROI, and driving cross-functional follow-through.
- Establish closed-loop tracking to ensure identified root causes are addressed and operational fixes are adopted.
- Create executive-ready reporting on provider issue trends, operational health, risks, blockers, and decisions needed.
View Full Description & ApplyYou'll be redirected to the employer's site
