Senior Analyst, Credentialing Quality & Data Operations
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What you'll do
- 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.
What they're looking for
- 3+ years of relevant experience in healthcare operations, credentialing, quality assurance or audit, provider data, data analysis, or a related field.
- 1+ years of identifing 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)
Nice to have
- 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.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
Hi, we're Oscar. We're hiring a Senior Analyst to join our Credentialing Quality & Data Operations 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:
The Senior Analyst, Credentialing Quality & Data Operations supports the accuracy, quality, compliance, and continuous improvement of credentialing and provider operations. Depending on the assignment, this role may focus on credentialing quality audits, operational and performance analytics, or serving as a subject-matter expert for practitioner and facility credentialing. The Senior Analyst turns findings and data into clear recommendations, resolves complex issues, strengthens controls, and partners across teams to improve provider experiences, regulatory readiness, and member outcomes.
You will report into the Senior Manager of Provider Operations Credentialing.
Work Location: This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories. Daily work is completed from your home office, with occasional travel required for team meetings and company events. #LI-Remote
Pay Transparency: The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $68,724 - $90,200.25 per year. The base pay for this role in all other locations is: $61,851.60 - $81,180.23 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
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.
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 identifing 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),
Bonus points:
- 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.
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.
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