Aimed at mid-level to senior healthcare operations professionals who excel in translating complex business rules into technical configurations and resolving system issues.
Derived from job-description analysis by Serendipath's career intelligence engine.
Original posting from Oscar Health via Greenhouse
Hi, we're Oscar. We're hiring a Sr. Analyst, Authorization Services Design & Configuration to join our team.
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the role:
You will be the architect of our medical management operations. You will design the workflows and business rules within our Utilization Management (UM) system to ensure seamless authorization processing. You will translate complex requirements into automated logic. You will handle internal escalations to identify causes and remediation pathways. As a subject matter expert, you will act to educate cross-functional partners on how our systems guide care decisions.
We are looking for a systems thinker with a collaborative mindset who enjoys solving complex, systems level problems.
You will report into the Associate Director, UM Optimization.
Work Location: This is a remote position, open to candidates who reside in: Dallas, TX. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote
Pay Transparency: The base pay for this role is: $67,813 - $89,005 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
Responsibilities:
Manage the configuration and maintenance of authorization workflows, rulesets, and automations within the UM platform.
You will translate business requirements into precise technical specifications, ensuring that business rules and logic are accurately represented, tested, and implemented.
Investigate and resolve escalations by performing root cause analysis on system behavior and configuration gaps.
You will Identify "friction points" in the authorization process and document formal opportunities for workflow improvement and automation.
Be the primary subject matter expert for the UM system, educating other teams (Product, Clinical, Regulatory) on how configuration impacts operations and supports our needs.
Develop testing protocols and implement test scenarios to validate expected system behavior and configuration accuracy. Lead corrective activities when system behavior deviates from expectations.
Manage assigned caseloads and project tasks through dashboard management and prioritization.
Maintain clear, comprehensive documentation of all business rules, technical specs, and workflow designs.
Other responsibilities as assigned.
Requirements:
2+ years of experience in system configuration, business rules management, or technical workflow design.
2+ years of experience in a technical/operational role involving root-cause analysis and data troubleshooting.
Intermediate to Advanced proficiency in Excel/Google Sheets (vlookups, pivot tables, and data manipulation).
Experience assessing and comprehending end-to-end process impacts in complex technical environments.
Strong communication skills with the ability to explain technical system logic to non-technical partners.
1+ year working knowledge of within the healthcare industry (payer or provider).
Bonus points:
Prior work experience in Prior Authorizations or Insurance Operations.
2+ years of proficiency in SQL, BigQuery, or similar database languages.
Experience using project management and communication tools like JIRA, Linear, and Slack.
Experience working with large datasets, data verification, and data management.
This is an authentic Oscar Health job opportunity.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.