Senior Analyst, Credentialing Quality & Data Operations

Oscar Health•Remote, AZ

11d•$61,852 - $90,200•Remote

About The Position

The Senior Analyst, Credentialing Quality & Data Operations supports the accuracy, quality, compliance, and continuous improvement of credentialing and provider operations. Depending on the assignment, this role may focus on credentialing quality audits, operational and performance analytics, or serving as a subject-matter expert for practitioner and facility credentialing. The Senior Analyst turns findings and data into clear recommendations, resolves complex issues, strengthens controls, and partners across teams to improve provider experiences, regulatory readiness, and member outcomes.

Requirements

3+ years of relevant experience in healthcare operations, credentialing, quality assurance or audit, provider data, data analysis, or a related field.
1+ years of identifying risks or data issues, perform root-cause analysis, and driving work to resolution.
Intermediate proficiency with Excel or Google Sheets, including data validation, reconciliation, analysis, and clear presentation of findings.
Experience conducting healthcare credentialing quality audits, documentation, and corrective-action follow-up
Experience analyzing operational datasets and building reports or dashboards; extensive credentialing knowledge is not required, though the ability to learn credentialing concepts and data is essential.
Knowledge of practitioner and facility credentialing (including primary-source verification and regulatory requirements)

Nice To Haves

Experience in a health plan, delegated credentialing entity, credentialing verification organization, provider organization, or other regulated healthcare environment.
Proficiency with SQL, BigQuery, or a similar query language and experience working with large datasets, data models, visualization tools, or business-intelligence platforms.
Experience using credentialing, provider data, workflow, ticketing, or audit-management systems.
Knowledge of NCQA, CMS, state, federal, and delegated-oversight requirements relevant to credentialing operations.
Relevant professional certification or formal training in credentialing, healthcare quality, auditing, compliance, or data analytics.

Responsibilities

Perform complex operational work across credentialing, provider data, quality assurance, and analytics following applicable requirements, policies, procedures, and service-level expectations.
Evaluate practitioner and facility credentialing records, workflows, source documentation, and system data for accuracy, completeness, timeliness, consistency, and compliance.
Plan and complete risk-based or routine quality audits; select samples, document evidence, score results, identify error patterns, and communicate clear, supportable findings.
Analyze complex datasets using spreadsheets, reporting tools, database queries, or other analytical methods to measure quality, productivity, timeliness, inventory, and operational performance.
Build, maintain, and validate reports, dashboards, metrics, and monitoring controls; investigate data anomalies and reconcile information across sources of truth.
Perform root-cause analysis and translate audit results, data trends, and operational insights into corrective and preventive actions, process improvements, and measurable recommendations.
Be a credentialing resource on practitioner and facility requirements, including initial credentialing, recredentialing, verification, file review, committee preparation, delegated activities, and related provider data dependencies.
Support remediation of complex quality, data, or credentialing issues; track action plans through closure and validate that corrective actions are effective and sustained.
Coach team members and share subject-matter guidance.
Manage assigned projects, analyses, audits, escalations, and caseloads independently while meeting quality, documentation, and timeliness expectations.
Other duties as assigned.