Oscar Health - Senior Analyst, Credentialing Quality & Data Operations
Requirements
• 3+ years of relevant experience in healthcare operations, credentialing, quality assurance or audit, provider data, data analysis, or a related field. • 1+ years of identifying risks or data issues, perform root-cause analysis, and driving work to resolution. • Intermediate proficiency with Excel or Google Sheets, including data validation, reconciliation, analysis, and clear presentation of findings. • Experience conducting healthcare credentialing quality audits, documentation, and corrective-action follow-up • Experience analyzing operational datasets and building reports or dashboards; extensive credentialing knowledge is not required, though the ability to learn credentialing concepts and data is essential. • Knowledge of practitioner and facility credentialing (including primary-source verification and regulatory requirements), • Experience in a health plan, delegated credentialing entity, credentialing verification organization, provider organization, or other regulated healthcare environment. • Proficiency with SQL, BigQuery, or a similar query language and experience working with large datasets, data models, visualization tools, or business-intelligence platforms. • Experience using credentialing, provider data, workflow, ticketing, or audit-management systems. • Knowledge of NCQA, CMS, state, federal, and delegated-oversight requirements relevant to credentialing operations. • Relevant professional certification or formal training in credentialing, healthcare quality, auditing, compliance, or data analytics. • This is an authentic Oscar Health job opportunity.
Responsibilities
• Perform complex operational work across credentialing, provider data, quality assurance, and analytics following applicable requirements, policies, procedures, and service-level expectations. • Evaluate practitioner and facility credentialing records, workflows, source documentation, and system data for accuracy, completeness, timeliness, consistency, and compliance. • Plan and complete risk-based or routine quality audits; select samples, document evidence, score results, identify error patterns, and communicate clear, supportable findings. • Analyze complex datasets using spreadsheets, reporting tools, database queries, or other analytical methods to measure quality, productivity, timeliness, inventory, and operational performance. • Build, maintain, and validate reports, dashboards, metrics, and monitoring controls; investigate data anomalies and reconcile information across sources of truth. • Perform root-cause analysis and translate audit results, data trends, and operational insights into corrective and preventive actions, process improvements, and measurable recommendations. • Be a credentialing resource on practitioner and facility requirements, including initial credentialing, recredentialing, verification, file review, committee preparation, delegated activities, and related provider data dependencies. • Support remediation of complex quality, data, or credentialing issues; track action plans through closure and validate that corrective actions are effective and sustained. • Coach team members and share subject-matter guidance. • Manage assigned projects, analyses, audits, escalations, and caseloads independently while meeting quality, documentation, and timeliness expectations. • Other duties as assigned.
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