Hi, we're Oscar. We're hiring a Senior Manager, Medical Economics to join our Medical Economics.

Oscar is the first health insurance company built around a full stack technology platform & a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.

About the role:

The Senior Manager, Medical Economics, leads a team of analysts to guide next steps to support Oscar's total cost of care (TCoC) strategy & efforts.

The Senior Manager collaborates with analytical leads across forecasting, medical economics, pricing, network analytics, & data science units to identify medical expense saving opportunities & to develop sound projections & measurements of the medical cost effects & clinical outcomes of programs, with an ultimate goal of improving total cost of care & driving affordability value. You will partner with Oscar's Office of Clinical Affairs & data science team to ensure accurate projections of clinical policy initiatives are reflected in management reporting e.g. financial close, forecasts, program performance monitoring.

You will report into the Senior Director, Medical Cost Analytics.

Work Location: This position is based in our Tempe, AZ office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings & events, while your other two office days are flexible to suit your schedule. #LI-Hybrid

Pay Transparency: The base pay for this role is: $142,560 - $187,110 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program & annual performance bonuses.

Responsibilities:

• Lead team programs to identify & measure cost-saving programs.
• Provide mentorship, & development planning for team members to promote growth & learning.
• Maintain current knowledge of medical economics best practices, & drive innovation & new approaches.
• Develop proactive financial models to assess the potential cost & use impacts of proposed clinical programs, network strategies, & policy changes. Conduct sensitivity analyses & stress-testing on models to understand the range of potential outcomes under multiple utilization & cost scenarios.
• Perform in-depth analysis of integrated claims & operational data e.g. medical, pharmacy, labs, authorizations) to identify cost & trend drivers.
• Design & build retrospective studies to measure the actual financial & clinical outcomes of implemented programs, comparing results against initial projections.
• Promote & shape best practices with respect to documentation.
• Contribute departmental improvements in automation, AI application, & analytic tooling to increase efficiency & the sophistication of your team's work.
• Serve a trusted analytic partner & advisor to team members in supported functional units.
• Maintain relationships & lines of communication with stakeholders.
• Influence & collaborate with stakeholders to guide strategic business decisions with respect to medical expense initiatives.
• Compliance with all applicable laws & regulations
• Other duties as assigned

Requirements:

• Bachelor's degree in a STEM field.
• 7+ years of relevant quantitative analysis experience.
• Proven experience in health insurance / payer analytics, with an understanding of medical claims data (e.g., CPT/HCPCS, ICD-10, DRGs) & standard healthcare industry data sources.

Bonus points:

• Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one.
• Significant experience analyzing & forecasting the financial impact of proposed changes to clinical policies, policy sets, utilization management processes, & clinical pathways.
• Experience developing measurement of clinical intervention ROI.
• Knowledge of prior authorization optimization & automation.
• Familiarity with pharmacy economics.
• Background in value-based care analytics.
• Experience translating between clinical, business, & analytic vocabularies.