Specialist, Member Services

Oscar Health•Florida, United States, FL

9d•Remote

About The Position

Oscar is seeking a Total Quality Management Specialist to join their Total Quality Management team. Oscar is a health insurance company that started in 2012 with a focus on serving its members, built on a full stack technology platform. The Specialist will be responsible for upholding quality standardization across all lines of business, ensuring the health of the quality program by providing expert oversight, identifying performance gaps, and representing the team in cross-functional calibrations. This role reports into the Lead, TQM.

Requirements

1+ years previous work experience in healthcare environment and quality assurance
1+ years of experience demonstrating strong quantitative and analytical skills, with a focus on proactively identifying issues and driving solutions.
Experience coaching peers or auditors
1+ years experience working with data and g-sheets reviewing data

Nice To Haves

Auditing and quality experience
Bilingual in Spanish
Experience in AI auditing programs
Advanced Operations Certificate (Lean Six Sigma or similar)
Previous project oversight experience

Responsibilities

Maintain the health and reliability of quality programs across all lines of business by ensuring standardization and consistent application of evaluation rubrics
Evaluate and resolve high-complexity cases that fall outside conventional workflows, focusing on root-cause identification and systemic resolution
Oversee internal and external escalated transactions to ensure resolutions meet both service-level agreements and quality benchmarks
Serve as the Subject Matter Expert for quality standards and cross-functional feedback
Support the testing and implementation of new quality programs, workflows, and audit approaches, including AI-driven initiatives
Compliance with all applicable laws and regulations
Other duties as assigned