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Senior Operations Director, Risk Adjustment Programs & Strategy

Oscar Health
New York, NY
  • Expired: over a month ago. Applications are no longer accepted.
Job Description

Hi, we're Oscar. We're hiring a Senior Director to join our Value Capture team.

Oscar is the first health insurance company built around a full stack technology platform and a 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

The Senior Director of Risk Adjustment will guide the advancement of Oscar's value capture plans for its ACA and MA populations. You will be responsible for strategic planning and program design & optimization, ensuring that Oscar's risk adjustment programs are efficient, effective, and compliant. You will need to collaborate with partners across the enterprise to develop new programs and improve existing retrospective and prospective risk adjustment programs. You will lead a team with strong analytic and program management skills that develop and oversee the risk adjustment operations budget, planning for major projects (e.g. the annual chart retrieval process, RADV), and managing important partners and vendors.

You will report to the VP, Value Capture.

This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $204,000 - $267,750 per year. The base pay for this role in all other locations is: $183,600 - $240,975 per year. You are also eligible for employee benefits, company equity grants and annual performance bonuses.

  • 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 important 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 plans.
  • Be the liaison between Product Development, Revenue Operations, P&L/Network and Data Science to ensure the business requirements are heard and applicable.
  • Maintain in-depth knowledge of our business and regulatory environments.
  • Provide subject matter expertise in the determination of benchmarks, goals, and outcomes for corporate-wide Risk Adjustment projects.
  • Bachelor's degree or commensurate experience
  • 10+ years of experience in health care or managed care
  • 8+ years of operational strategy, execution, and P&L management
  • 5+ years of experience in Medicare Advantage or ACA products
  • 5+ years of experience in risk adjustment
  • 5+ years leading a team
  • Financial planning, strategic analysis, and budget management experience
  • Operational experience building and designing new programs
Bonus Points
  • Masters degree in Business, Finance, or Healthcare related field
  • Certified risk adjustment coder

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

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, paid holidays, paid vacation and sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

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 ( to make the need for an accommodation known.

To protect the health and safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices, employees conducting sales work in the field and employees conducting at-home or in-person visits with members.

Oscar Health


New York, NY



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