Director, Provider Operations

Oscar Health•Tempe, AZ

1d•Hybrid

About The Position

Oscar is hiring a Director to join their Provider Operations team. Oscar is a health insurance company that utilizes a full stack technology platform and focuses on serving its members. The Director, Provider Operations will be responsible for building, scaling, and optimizing Oscar's provider data management, contracting, and credentialing processes. This role involves setting the vision and strategy for provider operations and data functions, and designing processes to enhance Oscar's capabilities in serving both members and providers. The position requires collaboration with cross-functional partners and stakeholders to bring ideas from conception to implementation. The role reports to the Vice President, Network Operations.

Requirements

A bachelor's degree or 5+ years of operating experience
10+ years of work in operations, health insurance, data analysis and/or consulting
5+ years of experience building, coaching and developing operational teams
5+ years experience with network operations, provider data management and contracting processes
5+ years prior successful experience developing and managing large scale initiatives coordinating with internal and external stakeholders
5+ years of experience designing and improving business process for optimization as well as standing up accompanying operating and technical procedures
5+ years of experience using data to influence business decisions
5+ years of experience program management

Nice To Haves

Proven history of managing high-impact initiatives and pitching complex business cases to secure alignment from executive leadership.
Proficiency in SQL, Lean Six Sigma, or other process improvement methodologies
Deep understanding of data architecture and optimizing data management workflows
Direct experience operating within service-oriented organizational structures
Comprehensive knowledge of NCQA credentialing, CMS standards, and the No Surprises Act.
Prior success in deploying or refining enterprise-level MDM or Provider Data Management systems.
Demonstrated ability to apply AI, RPA, or data analytics to improve roster accuracy and processing speed.
Background in leading distributed teams and overseeing external BPO or vendor partnerships.

Responsibilities

Provide strategic leadership and operational oversight for the end-to-end provider data lifecycle, ensuring the precise and timely execution of provider credentialing, contract loading, and daily data management.
Lead, coach, and develop a high-performing, multi-tiered team of managers and individual contributors; foster a culture of continuous learning, accountability, and psychological safety.
Establish clear organizational structure, governance, and support systems that shield the team from distractions and empower them to execute key strategic initiatives.
Act as a trusted, collaborative partner to Product, Tech, Markets, and Clinical Operations to design, build, and deliver next-generation provider operations capabilities that support aggressive company growth and market expansion targets.
Architect and implement foundational, industry-standard processes and data models that allow the provider data and contracting infrastructure to scale seamlessly alongside the business.
Champion the adoption of industry best practices to ensure all operational processes and internal tools are highly extensible, efficient, and integrated with modern technology stacks.
Lead the team in surface-level and deep-dive diagnostics to identify data, process, and technology bottlenecks.
Establish robust KPIs and monitoring dashboards to proactively flag operational issues, leveraging these insights to maintain our standing as a leading health plan.
Identify and execute opportunities for automation (e.g., RPA, AI integrations) across mature, stable workflows to replace manual intervention, reduce turnaround times, and eliminate human error.
Drive administrative expense savings and optimize total cost of care by identifying and executing on process improvements, technical tooling investments, offshore resource optimization, and strategic vendor partnerships.
Guarantee 100% compliance with all applicable state and federal laws, regulatory mandates (e.g., No Surprises Act, CMS requirements), and accreditation standards (NCQA).
Adapt to evolving business needs by leading critical ad-hoc initiatives and specialized projects as assigned.