Analyst, Risk Adjustment

Oscar Health•New York, NY

2d•$75,348 - $98,894•Hybrid

About The Position

Oscar is hiring an Analyst, Risk Adjustment to support the day-to-day execution and performance of its Prospective Risk Adjustment programs. Risk Adjustment accounts for differences in members’ health needs and expected costs of care. Accurate, complete clinical documentation helps ensure a member’s health status is appropriately represented. Prospective Risk Adjustment supports healthcare providers in reviewing members’ health information and documenting conditions addressed during care in accordance with applicable clinical coding and documentation requirements. Program activities may include sharing relevant clinical information with providers at the point of care, conducting virtual or in-home health assessments, and providing reports of historical or suspected conditions for provider review and clinical validation. The Analyst partners with internal teams and external vendors to support operational workflows, accurate program data and reporting, appropriate claims processing, and timely identification and resolution of issues. The role supports Point-of-Care tools, Virtual Health Assessments (VHA), In-Home Assessments (IHA), and provider reporting initiatives. It is suited to an analytical, detail-oriented professional interested in developing expertise in Risk Adjustment and healthcare operations. The position is based in Oscar’s New York, NY office and follows a hybrid schedule with three in-office days per week. Thursdays are required in the office; the other two in-office days are flexible. The role reports to the Sr. Manager, Strategic Initiatives (Risk Adjustment).

Requirements

Strong analytical and problem-solving skills, including the ability to investigate operational or data-related issues and support resolution.
Strong attention to detail and organizational skills, including 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 and ability to collaborate across teams and with external partners.

Nice To Haves

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.
Work experience within a health plan, provider organization, healthcare technology company, or other healthcare environment.
Exposure to prospective Risk Adjustment programs, health assessments, Point-of-Care workflows, provider gap programs, healthcare claims, or vendor operations.
Bachelor’s degree in a healthcare, business, analytical, or related discipline preferred.

Responsibilities

Support daily operations across prospective Risk Adjustment programs, including Point-of-Care tooling, VHA, IHA, and provider gap-reporting initiatives; monitor workflows, investigate operational issues, and coordinate resolution or escalation.
Support external vendors’ day-to-day operational needs, coordinate recurring deliverables and data exchanges, respond to operational questions, track issues and action items, and work with vendors and internal stakeholders to resolve issues promptly.
Develop and maintain recurring reports, trackers, and analyses on program performance, assessment activity, provider participation, vendor performance, claims activity, and other operational metrics.
Validate and reconcile data across internal and vendor sources to identify discrepancies, trends, and opportunities for operational improvement.
Support programs that provide healthcare providers with relevant member health information, including historical and suspected conditions, for review and clinical validation; assist with Point-of-Care tools, provider reporting, and related data, reporting, and workflow issues.
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 resolve them.