Senior Manager, Clinical & Disease Specific Insurance Solutions

Hi, we're Oscar. We're hiring an Senior Manager, Clinical & Disease Specific Insurance Solutions to join our Insurance Product Development 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 Manager, Clinical & Disease Specific Insurance Solutions, owns the end to end lifecycle of insurance products designed to serve members with specific clinical needs or disease profiles (e.g., diabetes, COPD). This role is accountable for product strategy, benefit design, launch, performance management, and ongoing optimization, ensuring plans improve access, remove barriers to care, improve clinical outcomes, and affordability, while remaining compliant and operationally scalable.

You will report into the Vice President, Insurance Product Innovation and Development

Work Location: This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Florida, Georgia, Illinois, Massachusetts, Michigan, Nevada, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, or Virginia. Note, this list of states is subject to change. #LI-Remote

Pay Transparency: The base pay for this role is: $149,040 - $195,615 per year in New Jersey, New York, and California. The base pay for all other locations is: $134,136 - $176,053 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Clinical & Disease Specific Plan Strategy & Design

  • Own the full end to end lifecycle of clinical and disease specific insurance products from ideation/strategy and benefit design through launch, performance management, and optimization aligned to outcomes, regulatory requirements, affordability and growth objectives

  • Build and manage business cases for new and existing products, including financial modeling, membership projections, and ongoing performance tracking against goals

  • Analyze product performance using financial and membership metrics to forecast results, identify risks and opportunities, and inform decision-making

  • Lead benefit design for disease-specific plans, including augmenting existing offerings, remediating underperforming designs, and introducing new benefit structures informed by clinical insight, utilization patterns, and product performance

  • Design and manage product portfolios aligned to defined clinical populations, such as members with chronic conditions, high cost, or high utilization profiles, or condition specific care needs

  • Contribute to annual planning, roadmap development, and prioritization for clinical and disease-specific products

  • Identify risks, gaps, and opportunities across benefit design, performance, affordability, and access, recommending corrective actions as needed

   

  Execution, Filings and Regulatory Alignment

  • Responsible for execution of clinical plan designs through internal approvals, filings and supporting documentation

  • Partner with regulatory and legal teams and incorporate federal and state regulatory guidance, clinical mandates and medical policy changes into plan designs and pricing inputs.

  • Ensure compliance with all applicable laws, regulations, and internal governance standards

   

  Cross Functional Leadership & Collaboration

  • Serve as the primary product directly responsible individual (DRI) for clinical plans, coordinating all necessary plan aspects  across Clinical, Actuarial, Network, Medical Affairs, Finance,  Legal and Compliance

   

  Performance & Optimization

  • Develop and maintain regular performance reporting and product look-backs, assessing financial, clinical, operational, and outcomes across disease-specific populations

  • Lead cross-functional execution for clinical product enhancements, pilots, and issue resolution

  • Compliance with all applicable laws and regulations

  • Other duties as assigned

  
  
  

Requirements:

• 6+ years of experience developing, managing, or supporting commercial insurance products, including clinical programs and disease-specific product offerings

• 5+ years of experience and Understanding of clinical policy, utilization management, quality programs and regulatory requirements (ACA, state mandates, CMS guidance, etc…)

• 3+ years multi-year experience with ACA, including individual market place and small group products

• 3+ years demonstrated ownership of end to end product lifecycle management

• 3+ years experience and proven ability to lead   cross-functionally in highly regulated, matrixed and sometimes vague environments

• 3+  years experience making Strong analytical and data-driven decisions with Ability to translate population-specific insights into product and benefit design decisions

• Travel up to 25% of the time

Bonus points:

• Bachelor’s degree in business, healthcare, public policy, analytics, or related field

• Experience developing or managing clinically differentiated health plans.

• Familiarity with medical policy development, clinical governance and provider models.

• Experience supporting regulatory filings and audits

• Experience developing or managing products for chronic conditions, high-utilizer populations, or disease-specific cohorts

• Experience with business intelligence tools, experience with SQL, Excel, or similar tools

• Experience incorporating clinical outcomes, quality measures, and care management programs into product design

• Background in population health, value-based care, or care delivery innovation a plus