Program Lead, Payor Connections/Interoperability

About the role

You will lead interoperability initiatives that connect Oscar with external provider systems and data sources. This role requires ownership of end-to-end processes from initial requirements gathering through final implementation and monitoring. You will represent the Risk Adjustment team in all external and internal communications regarding data acquisition and system integrations. The position demands comfort with ambiguity and the ability to build scalable processes from the ground up. You will collaborate closely with engineering, product, and operations to ensure technical solutions meet business and compliance needs. Success in this role means enabling accurate and timely healthcare data flow that supports member care and internal analytics.

Key facts

What you'll do

Lead interoperability projects that establish connections with provider organizations and third party vendors.

Develop and nurture strategic relationships with provider group partners and technology vendors to support data exchange initiatives.

Create comprehensive project plans that outline scope, timelines, dependencies, and resource requirements for interoperability work.

Help develop operational strategy and market approach for payor connections that align with Oscar's member first philosophy.

Collaborate across Oscar teams to identify actions that drive improvements and monitor the impact of interoperability initiatives on data accuracy and timeliness.

Direct the testing and validation of data connections to confirm compliance with regulatory standards and functional requirements.

Oversee the creation, maintenance, and enhancement of essential operational dashboards used to track interoperability performance and usage.

Track development progress, resolve issues related to data quality or system integration, and ensure continuous improvement in program outcomes.

Serve as a TEFCA subject matter expert within the Risk Adjustment team and contribute to related governance activities.

Ensure compliance with all applicable laws, regulations, and internal policies governing payor data acquisition and exchange.

Support the definition of success metrics and reporting frameworks for interoperability initiatives.

Perform other duties as assigned by leadership to address evolving business and member needs.

Act as a primary point of contact for internal stakeholders seeking guidance on payor connection capabilities and limitations.

Champion the adoption of standardized interoperability practices across the Risk Adjustment function.

Requirements

You must have 3+ years of work experience in health care operations or health insurance; working directly with provider groups.

You must bring 2+ years of experience in delivering interoperability projects or programs in a healthcare context.

You must possess in depth knowledge of TEFCA and its implications for data exchange.

You must demonstrate strong analytical skills to interpret complex requirements and translate them into technical solutions.

You must be able to work fully remotely while maintaining high productivity and communication standards.

You must be available to work from one of the following states: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia.

You must comply with all company policies and procedures related to remote work and professional conduct.

You must have a proven track record of managing projects that involve multiple stakeholders and conflicting priorities.

You must be comfortable using tools and platforms that support data validation, monitoring, and reporting.

You must be comfortable working with technical and non-technical audiences and explaining complex concepts clearly.

You must be committed to ongoing learning and adapting to changes in healthcare policy and technology.

You must demonstrate integrity and reliability in meeting deadlines and honoring commitments.

Nice to have

Risk Adjustment experience within a health plan or related setting.

Basic SQL or BQ query writing experience to validate data structures and troubleshoot issues.

Practical notes

This is a remote position open to candidates residing in specified states.

Compensation varies by location with defined minimum and maximum ranges.

Eligibility for employee benefits and participation in Oscar's unlimited vacation program applies.

Annual performance bonuses are part of the compensation structure.

No additional hours, travel, visa, or application deadline requirements are specified in this description.