Senior Specialist, Network Contracting

Summary

Join Oscar's Provider Network team as a Senior Specialist, Network Contracting! You will intake, process, and negotiate post-service single-case agreements, ensuring fair claim handling under regulations like the No Surprises Act. This role involves research, strategy, communication, and coordination of IDR-related matters. You may also recruit new providers, resolve provider issues, and support cost-saving initiatives. The position reports to the Senior Director, Specialty Contracting and is a Management Level 3 role. Work location is blended, with at least two days per week in the office (NYC, Tempe, or LA) if within commuting distance; otherwise, it's remote. The role offers a competitive salary and benefits package.

Requirements

• 2+ years of experience in provider network operations or contracting or provider services
• 1+ years of experience in Health Insurance (Individual and/or Medicare Advantage) and/or Healthcare industry
• 1+ years experience navigating and organizing large data sets such as claim files and provider rosters

Responsibilities

• Negotiate with Out-Of-Network (OON) providers/facilities to achieve favorable single case rates and avoid mediation/arbitration when possible
• Support and direct involvement with negotiating contracts with assigned healthcare providers, focusing on favorable terms and compliance with organizational standards, strategy, and regulatory requirements
• Conduct comprehensive reviews and analyses of assigned provider contracts, identifying areas for improvement and optimization
• With support from your leader, utilizes data and analytics of provider financial issues and competitor strategies to inform negotiation and contracting decisions
• Support implementation of contracting policies and workflows; monitors and ensure efficient contracting processes are in place
• With input and support from their leader, monitor and analyze key metrics for network performance, cost, and provider satisfaction, and provide reports to leadership for assigned provider accounts
• Ensure and professional resolution of provider issues Build and with healthcare providers to ensure network stability and quality
• Help track and analyze key performance indicators (KPIs) to monitor provider satisfaction and operational efficiency
• Support provider onboarding, training, and resource distribution
• Collaborate with internal teams such as Claims, Credentialing, and Contracting to resolve routine provider issues
• Participate in process improvement plans to optimize workflows and enhance provider experience
• Compliance with all applicable laws and regulations
• Other duties as assigned

Benefits

• 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