Director, Medical Economics

Role Description

The Director, Medical Economics, plays an instrumental role in Oscar's medical economics operating model, serving as a dedicated, proactive financial and analytic partner to a Market Vice President. You will be the point person accountable for supporting trend management and achieving market affordability targets. Rather than just tracking data, you will identify, size, and diagnose medical cost and utilization drivers, translating data into action. You will work as a strategic "quarterback," to triage deep-dive analytics to centralized analytic teams such as network performance, forecasting, and data science when appropriate, while maintaining deep understanding and ownership over your markets' context, goals, and results. You will manage your team to contribute analyses, reports, and dashboards to the medical economics tooling suite, building to meet market level needs in a way that is standardized, repeatable and re-usable across markets.

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

Work Location: This is a remote position, open to candidates who reside in: Atlanta, GA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $178,848 - $234,738 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities

• Trend Management Accountability & Partnership:
  • Partner with regional Market teams, regional actuaries, and market medical officers to co-lead regional trend management and drive total cost of care reduction strategies.
• Proactive Opportunity Identification:
  • Lead the proactive identification, sizing, and root-cause analysis of medical cost and utilization anomalies ("flares") and identification of affordability opportunities within assigned regions.
• Executive Communication:
  • Present comprehensive, executive-ready analytics and materials.
• Team Leadership:
  • Mentor analysts in developing both analytic expertise and "soft skills," specifically regarding business writing, data visualization, and partner influence.
• Analytic Quarterbacking:
  • Act as a primary gateway and triage point for your market team's medical economics requests, effectively routing complex requests to centralized analytic teams such as network performance, forecasting, and data science when appropriate, while managing end-to-end follow-up with market leadership.
• Affordability Integration:
  • Connect local market programs and emerging cost flares into Oscar's centralized affordability framework and governance programs.
• Playbook Development:
  • Collaborate with central affordability and local market teams to develop localized trend management strategies.
• Shared Tooling & Innovation:
  • Contribute to the department's core tooling strategy by building analytics tailored to specific market needs with an eye toward scaling them into national solutions via our internal tooling program.
  • Develop best practices in analytics, automation, and documentation, contributing to department programs around innovation, and tooling improvements.
  • Improve adoption of generative AI tools to improve team effectiveness.
• Enablement & Self-Service:
  • Provide support and training to market leadership teams to ensure self-service utilization of medical economics reports & tooling.
• Cross-Pollination:
  • Promote operational efficiency and shared learning by actively sharing successful tactics, playbooks, and localized analytic tools across different regional markets.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Qualifications

• Bachelor's degree in a STEM field, or 4 years commensurate experience.
• 10+ years of quantitative analysis in the healthcare industry.
• Experience with medical economics, corporate strategy, or a related analytics-driven leadership role.
• Experience with health insurance / payer analytics, with an understanding of medical claims data (e.g., CPT/HCPCS, ICD-10, DRGs) and standard healthcare industry data sources.

Bonus Points

• Business writing and storytelling skills; ability to simplify complex actuarial concepts for executive audiences.
• Familiarity with ACA-specific healthcare dynamics and how they impact external financial reporting.
• Fellow of the Society of Actuaries (SOA), or on the track to become one.

Benefits

• Participation in Oscar's unlimited vacation program.
• Company equity grants.
• Annual performance bonuses.
• Medical, dental, and vision benefits.
• 11 paid holidays.
• Paid sick time.
• Paid parental leave.
• 401(k) plan participation.
• Life and disability insurance.
• Paid wellness time and reimbursements.