At Oscar, we are re-envisioning healthcare by bringing technologists and industry experts together. We believe that great technology can revolutionize the operations and infrastructure underlying today’s healthcare and insurance systems, and is key to delivering transformative experiences for our members and the medical experts who provide their care. Oscar engineers work on some of the most challenging problems in tech — helping users navigate the complex health industry through beautiful user applications, elegant distributed system design, making sense of noisy data, statistical learning, and language theory. We invest in our people, our tools, and our processes so we can focus on solving big problems while learning from one another.
What you will be doing:
In this role, you will oversee Risk Adjustment and STARS for both Oscar’s Medicare Advantage and commercial books of business. You will oversee the teams that run Risk Adjustment and STARS operations and program management, and coordinate strategy and governance across the company. This includes working on plan design, provider contracts, and vendor negotiations that all reinforce the collective goals of capturing value and risk revenue from Oscar’s population.
For Risk Adjustment, you will have ultimate responsibility for the success of Oscar’s risk transfer and the end-to-end process that determines it, from plan design and contract terms to submitting our data to CMS servers. For STARS, you will ensure Oscar will be on track to achieve 4+ STAR performance in Medicare Advantage and you will oversee the team responsible for HEDIS chart retrieval and abstraction. You will work closely with almost every team at Oscar that touches Risk Adjustment and STARS, including Legal, Actuarial, Product, Engineering, Data, Compliance, Plan Design, Contracting, Population Health, Case Management, and more.
What leads to success:
Both Risk Adjustment and STARS are complex operations, in the background of a constantly changing regulatory environment, and with nuances between commercial and MA. We’re looking for someone who likes to take on a challenge and can lead independently.
We think you will be successful if you...
- Have 7 years of experience, particularly with Risk Adjustment and STARS
- Are a leader at a healthcare and/or insurance company
- Understand Risk Adjustment, risk transfers payment, and the differences between commercial and Medicare Advantage
- You have Medicare Advantage Quality Improvement & STARS experience ideally both Part C and Part D
- You have been personally accountable for achieving STARS outcomes, and have built or managed high-performing STARS programs
- Enjoy managing complex programs with a large number of overlapping work streams
- Can work cross-functionally to deliver on key business objectives, obtain organizational consensus and alignment, and drive the entire organization forward
- Think strategically, creatively and pragmatically about highly regulated spaces
- Take a systematic approach to high-stakes decisions on tight deadlines, develop contingency plans, and mitigate operational and business risk systematically
- Are comfortable reporting concise takeaways to executive leadership
- Have a data-oriented mindset and analytical capabilities
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we work to cultivate an environment where exceptional people can be their most authentic selves and find both belonging and support. We're on a mission to change healthcare -- an experience made whole by your unique background and perspectives.
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 ([email protected]) to make the need for an accommodation known.
Pay Transparency Policy: Oscar's Pay Transparency Policy ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.
Founded in 2012, Oscar is probably the last thing you would expect from a technology startup – a seemingly old-fashioned healthcare insurance provider. The company provides clients with the kind of clarity and simplicity we have come to expect from an e-commerce site. And, of course, they're hiring.
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Want to learn more about Oscar? Visit Oscar's website.
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