Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members.
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.
You will report into the Associate Director, UM Optimization.
Responsibilities
Manage the configuration and maintenance of authorization workflows, rulesets, and automations within the UM platform.
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.
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.
Develop testing protocols and implement test scenarios to validate expected system behavior and configuration accuracy.
Manage assigned caseloads and project tasks through dashboard management and prioritization.
Maintain clear, comprehensive documentation of all business rules, technical specs, and workflow designs.
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 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.
Conditions
This position is based in our Tempe, AZ office, requiring a hybrid work schedule with 3 days of in-office work per week.
Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule.
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.
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.