Senior Specialist, Network Contracting

About the role

You will own the end to end lifecycle of complex provider contracting within your designated market or region. This role requires direct negotiation of Single Case Agreements (SCAs) with hospitals and individual providers to close network gaps. You will analyze dense provider performance data to justify reimbursement rate adjustments and favorable terms. The position demands strict adherence to regulatory compliance and internal policy during every interaction. You will partner closely with legal and finance to ensure all contract language aligns with organizational strategy. A key part of this role involves proactively resolving escalated provider disputes and financial inquiries. You will also identify and recruit new network providers to support member access to care. This position reports directly to the Director of Network Contracting. Success in this role is defined by your ability to balance cost optimization with maintaining strong provider relationships.

Key facts

What you'll do

• Negotiate and finalize Single Case Agreements with hospital systems and individual providers to fill network gaps and ensure member access.
• Conduct detailed reviews of existing provider contracts to identify financial inefficiencies and areas for strategic optimization.
• Leverage analytics on provider financial trends and competitor positioning to build data driven negotiation strategies.
• Implement and monitor new contracting policies and workflows to improve process efficiency and compliance.
• Track and report on key network performance metrics including cost, utilization, and provider satisfaction to senior leadership.
• Serve as the primary point of contact for resolving timely and professional resolution of provider billing and service issues.
• Develop and maintain strategic relationships with key stakeholders to ensure network stability and continuity of care.
• Analyze key performance indicators related to network adequacy, cost containment, and provider onboarding timelines.
• Provide comprehensive support throughout the provider onboarding process including training and distribution of operational resources.
• Partner with internal departments such as Claims, Credentialing, and Contracting to resolve complex provider related cases.
• Drive continuous improvement by identifying bottlenecks in contracting workflows and proposing actionable enhancements.
• Ensure strict adherence to all federal, state, and local laws governing healthcare provider contracts and reimbursement.
• Perform other job related duties as assigned by management or leadership.
• Support the execution of network strategy initiatives that align with Oscar's long term business objectives.
• Facilitate communication between internal teams and external providers to streamline dispute resolution.

Requirements

• Must possess 2+ years of experience in provider network operations, contracting, or provider services.
• Must have 1+ years of experience within the health insurance sector specifically in Individual and/or Medicare Advantage lines.
• Must have 1+ years of hands on experience organizing and navigating large datasets such as claim files and provider rosters.
• Must be authorized to work in the United States and not require work authorization sponsorship from Oscar at this time.
• Must reside in one of the following states: Arizona, Florida, Georgia, or Texas.
• Must comply with all HIPAA regulations and internal privacy policies regarding protected health information.
• Must demonstrate strong analytical skills to interpret financial and performance data.
• Must have excellent written and verbal communication skills for professional interactions with providers.
• Must be proficient in Microsoft Office Suite and common business software applications.
• Must be able to manage multiple priorities and deadlines in a fast paced remote environment.
• Must adhere to Oscar's code of conduct and ethical standards in all professional interactions.
• Must follow all documented processes and procedures for contracting and network operations.
• Must maintain accurate and detailed records of all negotiations and communications.
• Must be available during standard US business hours for collaboration with cross functional teams.

Nice to have

• Associate's degree or equivalent professional working experience.

Practical notes

This role is fully remote but candidates must live in Arizona, Florida, Georgia, or Texas. Work from home is the standard arrangement with occasional travel required for team meetings and company events. The compensation range provided is $71,539 to $93,895 per year along with benefits and bonus eligibility. This position is eligible for Oscar's unlimited vacation program.