VP, Member & Provider Services and Optimization

About the role

You own the end-to-end performance, scalability, and continuous improvement of the member and provider service experience at Oscar. You will lead the Member and Provider Services organization, translating high-level strategic goals into actionable operational roadmaps that prioritize member satisfaction, provider engagement, and process optimization. You will architect a performance-driven organization by leading a multi-tiered team of Directors to meet rigorous KPIs while leveraging Oscar's internal platforms and data-driven insights. You will collaborate with internal and external peers to ensure service delivery acts as a key differentiator in the healthcare market. You will report into the SVP of Member & Provider Strategy.

Key facts

What you'll do

• Direct the Member & Provider Services organization, overseeing a scalable operating model designed to optimize the end-to-end experience for our entire service ecosystem, including members, providers, and broker call center operations.
• Summarize departmental strategies into concrete operational roadmaps, leading the implementation of programs that reduce friction in member navigation and provider service workflows.
• Cultivate a high-performance culture by guiding the evolution of specialized service tools and data-led workflows that empower teams to resolve complex member and provider needs.
• Define and refine the performance management philosophy, using member and provider feedback loops to set rigorous benchmarks for service excellence and continuous optimization.
• Define, socialize and implement the call center of the future, utilizing AI, automation, self-service, and analytics to accelerate Oscar's industry-leading member and provider experiences.
• Improve workforce mix to maximize flexibility, efficiency, business continuity, and overall service experience across all service channels.
• Serve as the primary voice of the customer, advising and directing internal projects to ensure they are aligned with our experience, quality, and compliance goals.
• Lead a multi-leveled organization, including managing multiple levels of managers, to exceed targets in quality and productivity while optimizing every interaction to balance member empathy with regulatory and fiscal requirements.
• Ensure teams are equipped and future-ready through advanced service tools, technology, and professional development, building a talent bench that fosters growth for both individual contributors and new leaders.
• Lead a culture of continuous optimization, using data-driven root cause analysis to identify systemic pain points in the member and provider experience and deploying sustainable, scalable solutions.
• Oversee budgeting and capacity planning, providing data-backed business cases for investments that scale our ability to support a growing member and provider base efficiently.
• Oversee the integration of quality improvement projects, ensuring that we improve member-facing and provider-facing programs to provide reliable, seamless access to care.
• Act as a senior Oscar ambassador to external partners and regulators, representing the department's optimized approach to member advocacy and provider relations.
• Ensure strict compliance with all applicable laws and regulations governing member and provider services operations.
• Perform other duties as assigned by senior leadership to support evolving business needs.

Requirements

• Bring 15+ years of cumulative professional experience demonstrating leadership in complex, data-driven environments.
• Provide 5+ years of experience in managing a large organization, leading teams, and driving strategic execution.
• Show a proven track record of building and scaling high-performing teams in a fast-growth, technology-driven healthcare setting.
• Demonstrate expertise in developing and implementing service operations, process optimization, and performance management frameworks.
• Exhibit strong mastery of data analysis and the ability to use insights to drive decision-making and improve customer outcomes.
• Possess excellent written and verbal communication skills to influence senior stakeholders and represent Oscar externally with clarity and professionalism.
• Display deep knowledge of regulatory compliance and quality standards relevant to healthcare member services.
• Show a history of successfully implementing technology-driven service solutions, including AI, automation, and analytics platforms.
• Demonstrate the ability to thrive in a fast-paced, ambiguous environment while managing multiple priorities and deadlines.
• Commitment to fostering an inclusive, collaborative, and high-trust team culture that supports innovation and continuous improvement.
• Willingness to relocate to and maintain work authorization in New York, New York, as required for this role.
• Adherence to Oscar's core values and commitment to the company's mission of building a better healthcare system.

Nice to have

• Experience with AI, automation, and analytics platforms specifically within a healthcare service environment.
• Background in broker call center operations and member advocacy within a health insurance context.
• Familiarity with developing and managing service-level agreements (SLAs) and key performance indicators (KPIs) for large service organizations.
• Prior experience implementing quality improvement methodologies such as Lean or Six Sigma in a healthcare setting.
• Knowledge of health insurance products, provider networks, and regulatory compliance frameworks such as HIPAA and CMS guidelines.
• Experience with change management initiatives in large, complex organizations.

Practical notes

This role requires 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 the other two office days are flexible to suit your schedule. Compensation transparency is provided as noted in the key facts section. This position is eligible for company equity grants and participation in Oscar's unlimited vacation program.