Director, Medical Economics

Oscar Health•Dallas, TX

1d•Remote

About The Position

Oscar is seeking a Director, Medical Economics to join their Actuarial team. This role is crucial to Oscar's medical economics operating model, acting as a dedicated financial and analytic partner to a Market Vice President. The Director will be responsible for supporting trend management and achieving market affordability targets by identifying, sizing, and diagnosing medical cost and utilization drivers, translating data into actionable insights. This strategic role involves quarterbacking deep-dive analytics to centralized teams like network performance, forecasting, and data science, while maintaining a deep understanding of market context, goals, and results. The Director will also manage a team to develop analyses, reports, and dashboards for the medical economics tooling suite, ensuring standardization, repeatability, and reusability across markets. The position reports to the Senior Director, Medical Cost Analytics.

Requirements

Bachelor's degree in a STEM field, or 4 years commensurate experience.
10+ years of quantitative analysis in the healthcare industry.
Experience with medical economics, corporate strategy, or a related analytics-driven leadership role.
Experience with health insurance / payer analytics, with an understanding of medical claims data (e.g., CPT/HCPCS, ICD-10, DRGs) and standard healthcare industry data sources.

Nice To Haves

Business writing and storytelling skills; ability to simplify complex actuarial concepts for executive audiences.
Familiarity with ACA-specific healthcare dynamics and how they impact external financial reporting.
Fellow of the Society of Actuaries (SOA), or on the track to become one.

Responsibilities

Partner with regional Market teams, regional actuaries, and market medical officers to co-lead regional trend management and drive total cost of care reduction strategies.
Lead the proactive identification, sizing, and root-cause analysis of medical cost and utilization anomalies ("flares") and identification of affordability opportunities within assigned regions.
Present comprehensive, executive-ready analytics and materials.
Mentor analysts in developing both analytic expertise and "soft skills," specifically regarding business writing, data visualization, and partner influence.
Act as a primary gateway and triage point for your market team's medical economics requests, effectively routing complex requests to centralized analytic teams such as network performance, forecasting, and data science when appropriate, while managing end-to-end follow-up with market leadership.
Connect local market programs and emerging cost flares into Oscar's centralized affordability framework and governance programs.
Collaborate with central affordability and local market teams to develop localized trend management strategies.
Contribute to the department's core tooling strategy by building analytics tailored to specific market needs with an eye toward scaling them into national solutions via our internal tooling program.
Develop best practices in analytics, automation, and documentation, contributing to department programs around innovation, and tooling improvements.
Improve adoption of generative AI tools to improve team effectiveness.
Provide support and training to market leadership teams to ensure self-service utilization of medical economics reports & tooling.
Promote operational efficiency and shared learning by actively sharing successful tactics, playbooks, and localized analytic tools across different regional markets.
Compliance with all applicable laws and regulations.
Other duties as assigned.