Senior Specialist, Network Contracting
O
OscarHealth Insurance
Arizona; Florida; Georgia; or TexasFull-TimeSenior
Salary$71,539 - $93,895 per year
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Job Details
- Experience
- 2+ years of experience in provider network operations or contracting or provider services; 1+ years in Health Insurance; 1+ years navigating and organizing large data sets.
- Required Skills
- Data Analysis
Requirements
- 2+ years of experience in provider network operations, contracting, or provider services.
- 1+ years of experience in the Health Insurance industry, specifically Individual or Medicare Advantage.
- 1+ years of experience navigating and organizing large data sets, such as claim files and provider rosters.
- Ability to analyze provider financial performance and competitor strategies.
- Familiarity with contracting policies, workflows, and regulatory guidelines.
- Ability to build and maintain positive professional relationships with healthcare providers.
- Proficiency in monitoring KPIs and operational efficiency metrics.
- Associate’s degree preferred or equivalent professional working experience.
Responsibilities
- Negotiate and manage Single Case Agreements (SCAs) with healthcare providers to build and maintain a robust network.
- Analyze provider performance and reimbursement rates to optimize costs and ensure regulatory compliance.
- Recruit new providers to the network and assist with provider issue resolution.
- Conduct comprehensive reviews and analyses of provider contracts to identify optimization opportunities.
- Monitor and report on key network performance, cost, and provider satisfaction metrics.
- Support provider onboarding, training, and resource distribution.
- Collaborate with internal Claims, Credentialing, and Contracting teams to resolve issues.
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