Director, Medical Economics

Oscar Health Insurance-posted about 1 month ago
Full-time • Mid Level
Remote • Atlanta, GA
1,001-5,000 employees
Insurance Carriers and Related Activities
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The Director, Medical Economics, plays an instrumental role in Oscar's medical economics operating model. You will be the lead architect and developer of our next generation of analytic tools. This role is for a hands-on technical expert who will personally develop a unified reporting suite to lead Oscar's Medical Economics program, providing transparent, relevant insights into medical cost and utilization drivers. You will be a project lead collaborating with leaders across the Medical Economics team to incorporate their analytic content into the unified reporting suite. You will lead the department's engagement with partners in the data science team to deliver the foundational datasets and infrastructure upon which the reporting suite will be built. You will report to the Senior Director, Medical Cost Analytics.

  • Perform hands-on development while providing direction, guidance, and requirements to supporting matrixed resources from other analytic and tech teams.
  • Oversee decision-making responsibilities related to the technical design of a unified suite of medical economics reporting and analytic tooling that will be used to lead Oscar's Total Cost of Care (TCoC) efforts.
  • Partner with Medical Economics leaders to create a multi-year roadmap for the tooling suite, including creation of a governance process for designing content and analytic methodologies.
  • Develop automated dashboards and reports that decompose medical cost trends, highlighting important causes such as unit cost, utilization, mix of services, provider network changes.
  • Be the subject matter expert on Oscar's medical claims data, and incorporate key healthcare methodologies (e.g., risk adjustment, episode groupers, case-mix adjustment) into the tooling suite.
  • Ensure the tooling suite is designed to include generative AI for insight generation.
  • Be the internal consultant, introducing and applying techniques (e.g., predictive modeling, statistical analysis, machine learning) to enhance the sophistication and predictive power of our tooling suite.
  • Be the senior mentor and technical guide for analysts across the medical economics team, elevating the team's skills by promoting best practices in analytics and BI development.
  • Develop relationships and lines of communication with main partners across the operational departments.
  • Represent the medical economics function in cross-departmental forums, contributing to strategic planning.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned
  • Bachelor's degree in a STEM field, or 4 years commensurate experience.
  • 10+ years of quantitative analysis in the healthcare industry.
  • Demonstrated expertise in designing, building, and deploying business intelligence solutions and reporting tools from the ground up.
  • Advanced, hands-on proficiency with data querying and manipulation languages (e.g., SQL, Python) and BI platforms (e.g., Tableau, Looker, and Power BI).
  • 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.
  • Advanced degree (Master's or PhD) in a quantitative field such as Data Science, Statistics, or Computer Science.
  • Experience working with technology teams. Strong understanding of software development best practices as applied to healthcare analytics.
  • Experience working with large language models for development and data analysis.
  • Experience applying analytic methodologies (e.g., predictive modeling, statistical analysis, machine learning), preferably in a healthcare context.
  • Process management skills, with experience streamlining workflows and driving operational efficiency.
  • Collaborative and influential leadership style, with experience working across multiple teams and team members.
  • employee benefits
  • participation in Oscar's unlimited vacation program
  • company equity grants
  • annual performance bonuses
  • medical, dental, and vision benefits
  • 11 paid holidays
  • paid sick time
  • paid parental leave
  • 401(k) plan participation
  • life and disability insurance
  • paid wellness time and reimbursements
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