Specialist, Member Services at Oscar Health

United States

Hi, we're Oscar. We're hiring a Total Quality Management Specialist to join our Total Quality Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: You will be responsible for upholding quality standardization across all lines of business. Your role is to ensure the health of the quality program by providing expert oversight, identifying performance gaps, and representing the team in cross-functional calibrations. You will report into the Lead, TQM. Work Location: This is a remote role. You must reside in Arizona, Florida, Georgia, or Texas. Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. #LI-Remote Pay Transparency: The set rate for this role is $24.00 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year. Responsibilities: Maintain the health and reliability of quality programs across all lines of business by ensuring standardization and consistent application of evaluation rubrics Evaluate and resolve high-complexity cases that fall outside conventional workflows, focusing on root-cause identification and systemic resolution Oversee internal and external escalated transactions to ensure resolutions meet both service-level agreements and quality benchmarks Serve as the Subject Matter Expert for quality standards and cross-functional feedback Support the testing and implementation of new quality programs, workflows, and audit approaches, including AI-driven initiatives Compliance with all applicable laws and regulations Other duties as assigned Requirements: 1+ years previous work experience in healthcare environment and quality assurance 1+ years of experience demonstrating strong quantitative and analytical skills, with a focus on proactively identifying issues and driving solutions. Experience coaching peers or auditors 1+ years experience working with data and g-sheets reviewing data Bonus points: Auditing and quality experience Bilingual in Spanish Experience in AI auditing programs Advanced Operations Certificate (Lean Six Sigma or similar) Previous project oversight experience This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.