Vice President
Risk Adjustment Strategy & Solutions
Posted on 2/4/2023
Oscar Health

1,001-5,000 employees

Health insurance company
Company Overview
Oscar Health’s mission is to make high-quality health insurance accessible and affordable for everyone. The company is a software driven health insurance company that offers medical plans, medicare advantages, and small group products.
Experience Level
Desired Skills
Data Science
Data & Analytics
  • Bachelor's degree or commensurate experience
  • 15+ years of experience in health care or managed care
  • 10+ years of operational strategy, execution, and P&L management
  • 10+ years of experience in Medicare Advantage or ACA products
  • 8+ years of experience in risk adjustment
  • 10+ years leading and supporting a team
  • Financial planning, strategic analysis, and budget management experience
  • Operational experience building and designing new programs
  • Evolve Oscar's Risk Adjustment program strategy to achieve improved, consistent, and cost effective results, while eliminating sources of risk or performance uncertainty
  • Lead financial planning for all risk adjustment programs and manage to budget
  • Oversee all critical program vendors, including setting the strategy on outsourcing vs. insourcing, assessing new partner opportunities, initiating new relationships, and managing performance of existing partners
  • Drive continuous improvement by monitoring historical and current data trends to steer new program development and optimize performance of existing initiatives
  • Serve as liaison between Product Development, Revenue Operations, P&L/Network and Data Science to ensure the business requirements are heard and actionable
  • Maintain in-depth knowledge of the company's business and regulatory environments
  • Provide subject matter expertise in the determination of benchmarks, goals, and outcomes for corporate-wide Risk Adjustment initiatives
  • Ensure compliance with all revenant CMS requirements and processes
Desired Qualifications
  • Masters degree in Business, Finance, or Healthcare related field
  • Certified risk adjustment coder