Senior Network Contracting Specialist
Job Summary
The Senior Specialist, Network Contracting supports the team in managing provider relationships and improving contracting operations. This role focuses on resolving escalated issues and solving operational problems related to provider contracts. You will work across Florida, collaborating with internal data and network operations teams to maintain network stability.
Responsibilities
- Resolve escalated provider contract issues
- Negotiate provider contracts and ensure compliance
- Analyze provider data to inform business decisions
- Manage relationships to ensure network stability
- Collaborate on process improvement initiatives
Required Skills
- 2+ years provider network/contracting experience
- 1+ years Health Insurance industry experience
- Proficiency with large data sets and claim files
- Contract negotiation and relationship management
- Ability to work remotely and travel locally
Job Details
### Position Overview
The Senior Specialist of Network Contracting is responsible for supporting Associates and Managers in improving contracting and relationship management with providers in Oscar's networks. The primary focus is on escalated issue resolution and problem solving regarding internal operational issues and providers' contractual matters.
### Work Location
This is a remote position based in the field, open to candidates who reside in Florida. The work involves a blend of home office work and frequent local travel for client meetings, with occasional travel for team meetings and company events.
### Responsibilities
- Support and direct involvement with issue resolution and negotiating contracts, focusing on favorable terms and compliance with organizational standards, strategy, and regulatory requirements.
- Utilize data and analytics of provider financial issues and competitor strategies to inform business decisions.
- Adhere to defined metrics and SLAs including but not limited to provider outreach and contract completion.
- Build and maintain positive relationships with healthcare providers and ensure timely and professional resolution of provider issues to ensure network stability and quality.
- Collaborate with the provider services team regarding the servicing, education and communication to our provider network.
- Support provider onboarding, training, and resource distribution.
- Collaborate with internal teams such as Claims, Credentialing, and Contracting to resolve routine provider issues.
- Participate in process improvement initiatives to optimize workflows and enhance provider experience.
### Requirements
- 2+ years of experience in provider network operations or contracting or provider services.
- 1+ years of experience in Health Insurance (Individual and/or Medicare Advantage) and/or Healthcare industry.
- 1+ years experience navigating and organizing large data sets such as claim files and provider rosters.
- Bonus points: Associates degree or equivalent professional working experience.