Analyst, Risk Adjustment

Hi, we're Oscar. We're hiring a Analyst, Risk Adjustment to join our Risk Adjustment team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

• →Prospective Risk Adjustment Program Operations (30%) – Support daily operations across prospective Risk Adjustment programs, including Point-of-Care tooling, VHA, IHA, and provider gap-reporting initiatives. Monitor program activity and workflows to ensure processes are functioning as intended; investigate operational issues and coordinate resolution or escalation as appropriate.
• →Vendor Operations & Support (25%) – Support the day-to-day operational needs of external vendors. Coordinate recurring deliverables and data exchanges, respond to operational questions, track issues and action items, and partner with vendors and internal stakeholders to drive timely resolution.
• →Reporting, Data Analysis & Reconciliation (20%) – Develop and maintain recurring reports, trackers, and analyses to monitor program performance, including assessment activity, provider participation, vendor performance, claims activity, and other key operational metrics. Perform data validation and reconciliation across internal and vendor data sources to identify discrepancies, trends, and opportunities for operational improvement.
• →Point-of-Care & Provider Programs (15%) – Support programs that provide relevant member health information, including historical and suspected conditions, to healthcare providers for review and clinical validation. Support Point-of-Care tools and provider reporting initiatives and assist with resolving related data, reporting, and workflow issues.
• →Member & Claims Operations (10%) – Support member-level program operations, including reviewing and processing appropriate exclusions from VHA and IHA programs. Monitor and reconcile claims associated with prospective Risk Adjustment initiatives to ensure appropriate processing and payment; investigate discrepancies and partner with relevant teams to support resolution.

• Strong analytical and problem-solving skills, with the ability to investigate operational or data-related issues and support resolution.
• Strong attention to detail and organizational skills, with the ability to manage multiple priorities and recurring deliverables.
• Ability to work effectively with data, reporting tools, spreadsheets, and operational workflows.
• Strong written and verbal communication skills with the ability to collaborate effectively across teams and with external partners.

• Knowledge of healthcare operations, Risk Adjustment, claims, provider operations, or health plan processes.
• Experience analyzing data, identifying trends or discrepancies, and translating findings into actionable next steps.
• Proficiency with Excel or Google Sheets; familiarity with SQL, Tableau, Looker, or similar analytics tools is a plus.

• Bachelor’s degree in a healthcare, business, analytical, or related discipline preferred.