Senior Specialist, Network Contracting

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Quick Summary

Key Responsibilities

Support and direct involvement with negotiating contracts with assigned healthcare providers, focusing on favorable terms and compliance with organizational standards, strategy, and regulatory

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Hi, we're Oscar. We're hiring a Senior Specialist to join our Network Contracting 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.

About the Role

~1 min read

The Senior Specialist, Network Contracting is responsible for negotiating and managing Single Case Agreements (SCAs) with healthcare providers (hospital/health system and individual) to build and maintain a robust network in assigned market/region; while also ensuring access to quality care and optimizing costs by analyzing provider performance and negotiating reimbursement rates, often involving complex contract terms and compliance with regulatory guidelines. The Senior Specialist also plays a role in recruiting new providers to the network, assisting with resolution of provider issues, and supporting cost-saving initiatives.

You will report into the Director, Network Contracting.

Responsibilities

~1 min read

→Support and direct involvement with negotiating contracts with assigned healthcare providers, focusing on favorable terms and compliance with organizational standards, strategy, and regulatory requirements.
→Conducts comprehensive reviews and analyses of assigned provider contracts, identifying areas for improvement and optimization.
→With support from your leader, utilizes data and analytics of provider financial issues and competitor strategies to inform negotiation and contracting decisions.
→Supports implementation of contracting policies and workflows; monitors and ensures effective and efficient contracting processes are in place.
→With input and support from their leader, monitor and analyze key metrics for network performance, cost, and provider satisfaction, and provide reports to leadership for assigned provider accounts.
→Ensure timely and professional resolution of provider issues
→Build and maintain positive relationships with healthcare providers to ensure network stability and quality.
→Assist in tracking and analyzing key performance indicators (KPIs) to monitor provider satisfaction and operational efficiency.
→Support provider onboarding, training, and resource distribution..
→Collaborate with internal teams such as Claims, Credentialing, and Contracting to resolve routine provider issues.
→Participate in process improvement initiatives to optimize workflows and enhance provider experience.
→Compliance with all applicable laws and regulations
→Other duties as assigned

Requirements

~1 min read

2+ years of experience in provider network operations or contracting or provider services
1+ years of experience in Health Insurance (Individual and/or Medicare Advantage) and/or Healthcare industry
1+ years experience navigating and organizing large data sets such as claim files and provider rosters

Nice to Have

~2 min read

Associate’s degree or equivalent professional working experience.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

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Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

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