Senior Director, Escalated Provider Issue Resolution

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.

Experience standing up or transforming provider service, escalation, claims resolution, issue management, or operational governance functions.

The Senior Director, Escalated Provider Issue Resolution team supports strategic provider accounts, high-complexity escalations, root-cause remediation, and provider service governance.

This role will build and scale the operating model for escalated provider issue resolution, lead a multi-disciplinary team, and partner across Claims, Network, Utilization Management, Payment Integrity, Contact Center, Account Management, Technology, Analytics, and senior leadership to improve how Oscar identifies, routes, resolves, and prevents provider issues.

This position will report to the SVP, Network and Provider Management.

You will report into the SVP, Network & Provider Management

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.