Deliver these five beats in order — practice until they sound natural, not rehearsed
1Anchor on the ProblemProvider data and credentialing operations only work when the underlying data governance is right. That's not a new problem for me — it's the exact function I built from scratch at Aetna.
2The Builder StoryI inherited provider data quality under 60% with no dedicated organization behind it. I built the function, the governance model, and the cross-functional accountability that took it to over 99% — and kept it there through a major regulatory shift.
3The MatchProvider data management, contracting, and credentialing at scale, NCQA and CMS standards, No Surprises Act compliance, and driving accuracy through process and technology — this is the specific scope of the Director, Provider Operations role.
4Why NowI want to bring that operational build discipline to a company that's built health insurance around a modern technology platform — Oscar is applying AI and automation to exactly the kind of provider data problem I've spent my career solving.
5The CloseI'd welcome the chance to hear more about where provider data and credentialing operations stand today at Oscar, and where the incoming Director can have the fastest impact.
MDM/PDMProvider Data Systems
NCQA / CMSCompliance Standards
$164–215KPosted Base Range
| What the Role Owns | What This Means For You |
|---|
| Builds & scales provider data management, contracting, and credentialing | Sets vision and strategy for provider operations and data functions — the exact "build the function from scratch" work you did at Aetna. |
| Foundational processes for scaling provider data | Maps directly to your Provider Data Integrity build: governance frameworks, ownership policies, quality standards, cross-functional accountability. |
| NCQA credentialing, CMS standards, No Surprises Act | You led enterprise NSA compliance across 18M+ annual transactions — this is proven regulatory depth, not theoretical knowledge. |
| MDM / Provider Data Management systems, AI/RPA for roster accuracy | Your directory accuracy improvement (under 60% to over 99%) is the outcome Oscar is trying to engineer with technology — you've done it with process and governance, which is the harder half. |
| Leading distributed teams, overseeing BPO/vendor partnerships | You led teams of 400+ colleagues and managed vendor and cross-functional relationships at enterprise scale. |
| Lead, coach, and develop a high-performing multi-tiered team | Direct experience managing managers and individual contributors across a large distributed org. |
This role reports to a VP, Network Operations and sits a level below your most recent Executive Director title at Aetna. Don't undersell that — frame it as intentional: you want to be closer to the operational build again, in a company using modern technology to solve the problem you've solved manually. That's a strength, not a step down.
Your Future Manager
VP, Network Operations
You'll report directly into this VP. Confirm the name and background before your first-round call — LinkedIn search "Oscar Health VP Network Operations" and review their background for prior payer/provider-ops experience.
Say This"I'd want to understand what's working and what's fragile in the current provider data pipeline before I propose any changes — I've learned the hard way that governance beats heroics."
Likely Panel
Credentialing & Compliance Leads
Given the NCQA/CMS/NSA emphasis in the JD, expect at least one interviewer from compliance or credentialing operations who will probe your regulatory depth specifically.
Say ThisBe ready to speak fluently and specifically about NCQA credentialing standards and No Surprises Act provider directory requirements — not just at a high level.
Likely Panel
Technology / Data Partner
The JD calls out applying AI, RPA, and data analytics to roster accuracy — expect someone from data/engineering in the loop, even if informally.
Say This"I built the governance and accuracy discipline manually — I'm genuinely excited about what AI and automation can do to compress that timeline, and I want to be the person driving that adoption responsibly."
Team You'd Inherit
Multi-Tiered Managers & ICs
The role explicitly leads, coaches, and develops a multi-tiered team of managers and individual contributors — ask about team structure and tenure early.
Say ThisAsk how long the current team has been in place and what the biggest capability gap is — signals you're planning for their success, not just yours.
Q1"Tell me about building a provider data function from scratch."
Situation
As Senior Director, Provider Data Integrity at Aetna (2016–2020), provider data quality was under 60% with no dedicated organization to own it — creating compliance risk and downstream claims errors.
Task
Build a Provider Data Integrity organization from the ground up and turn data from a compliance burden into a strategic asset.
Action
Created the function, established data governance frameworks, ownership policies, and quality standards; built cross-functional accountability with IT, claims, credentialing, network, and compliance.
Result
Directory accuracy improved from under 60% to 90%+, then to over 99% by 2023 — this is the exact "foundational processes for scaling provider data" language in Oscar's posting.
This is your headline story for this interview. Lead every version of "tell me about yourself" back to this build.
Q2"How have you ensured compliance with credentialing and regulatory standards like NCQA, CMS, and the No Surprises Act?"
Situation
The No Surprises Act was enacted with aggressive implementation timelines across an organization processing 18M+ annual transactions for 1.8M+ providers.
Task
Lead enterprise-wide NSA compliance response with provider directory accuracy as the compliance foundation.
Action
Partnered with regulatory, legal, and operational teams to build compliant processes, leveraging the >99% directory accuracy already achieved.
Result
Successfully led the organization through NSA implementation with zero material regulatory violations.
If asked specifically about NCQA credentialing standards, be honest about depth — your strength is data governance and NSA; bridge to credentialing by noting your Data Integrity org had direct accountability alongside credentialing teams.
Q3"Describe how you've used process and technology to improve provider roster accuracy at scale."
Situation
As Executive Director, Network and Provider Data Services (2020–2023), managing a $53M budget and 400 colleagues, directory accuracy and transaction turnaround were core accountability metrics.
Task
Continue improving accuracy and speed without expanding cost.
Action
Delivered $3.5M favorable variance to the 2022 budget while reinvesting in process innovation; reduced average transaction turnaround from 16.5 to 9.5 days.
Result
$3.5M+ favorable variance, >99% directory accuracy (2022), turnaround nearly cut in half, 88% colleague engagement (91% survey response rate) — simultaneously.
Oscar wants AI/RPA applied to this exact problem. Frame your results as "achieved through process and governance discipline — which is exactly the foundation AI/RPA needs to scale further, not a replacement for it."
Q4"Tell me about managing external BPO or vendor partnerships."
Situation
As Executive Director, managed financial and operational performance of business-process vendor relationships spanning 300+ resources across multiple vendors, on top of a 400-colleague internal organization.
Task
Ensure external partners met quality and turnaround standards without direct day-to-day control.
Action
Implemented a Quality Oversight team specifically to reduce errors and improve member/provider satisfaction across vendor-supported work.
Result
Sustained accuracy and turnaround improvements across the full operation, internal and vendor-supported alike.
You have real numbers here — 300+ vendor resources across multiple partners, plus a dedicated Quality Oversight team you built. Lead with the Quality Oversight team detail; it shows you didn't just tolerate vendor risk, you engineered against it.
Q5"Tell me about leading a multi-tiered team of managers and individual contributors."
Situation
Across your Aetna career, you led a VBC team of 20+ as Senior Director (2009–2015), then a 400-colleague organization plus 300+ vendor resources as Executive Director (2020–2023).
Task
Develop managers who could develop their own teams, not just execute individually.
Action
Built accountability and coaching structures as part of the Provider Data Integrity build, with clear ownership at each org layer, plus a dedicated Quality Oversight function.
Result
88% colleague engagement (91% survey response rate) while hitting financial and accuracy targets — evidence the team development approach actually worked, not just looked good on paper.
Engagement score is your proof point here — most candidates can claim they "develop people," few can back it with a number.
Q6"Why Oscar Health, and why this level, given your Executive Director background?"
The Honest Answer
You want to be closer to hands-on operational build again, at a company using a modern technology platform to solve the exact problem you've solved with process and governance.
The Reframe
Title is not the point — scope and mission fit are. Oscar is trying to engineer what you already proved could work manually.
The Confidence Line
You're not looking for a lesser job — you're looking for the right problem, at a company where technology can amplify the discipline you already bring.
The Close
Ask what would make this Director seat successful in year one — shows you're evaluating fit both ways, not just trying to get any offer.
This question will come up, directly or indirectly. Answer it before they have to ask — get ahead of it in the opening pitch if the moment feels right.
Theme 01
I've Already Built This Function
Provider Data Integrity, built from zero to a >99% accuracy strategic asset. Oscar's "foundational processes for scaling provider data" is a description of work you've already completed once.
Theme 02
Governance Before Automation
AI and RPA amplify good governance — they don't replace it. You bring the discipline that makes automation actually work, not just look good in a pitch deck.
Theme 03
Regulatory Depth, Proven Under Pressure
Led enterprise NSA compliance across 18M+ annual transactions with zero material violations. This isn't theoretical regulatory knowledge — it's been tested at scale.
Theme 04
Right-Sized Scope, By Choice
Coming from an Executive Director seat to a Director role isn't a step back — it's a deliberate choice to get closer to the operational build again, at a company solving the exact problem you've spent your career solving. Say this plainly if it comes up. Confidence, not defensiveness.
Your Numbers — Decide These Now. Don't Negotiate In the Moment.
$210KYour Anchor (Top of Range)
$195KComfortable Landing Zone
$180KYour Floor — Do Not Go Below
| Scenario | Your Response |
|---|
| They ask your target | "Based on building and scaling a provider data function from the ground up to over 99% accuracy, plus enterprise-level NSA compliance leadership, I'm targeting $210K — the top of your posted range." Then stop talking. |
| They push back on budget | "I appreciate you sharing that. What's the range you're working with?" Then: "I can work with $195K if we revisit at the next review cycle." |
| Non-salary items | Equity grant size, sign-on bonus, remote/hybrid flexibility (confirm the 2-days-in-office expectation), professional development budget, title (Director vs Senior Director if org chart allows). |
| Ask This | Why It Works |
|---|
| "Where is the provider data pipeline most fragile today — is it the intake process, the credentialing handoff, or something downstream?" | Shows operator-level thinking, not just strategic talk. |
| "How mature is the current use of AI/RPA in roster accuracy — early pilots, or already in production?" | Signals genuine interest in the technology angle and helps you calibrate your pitch in later rounds. |
| "What does success look like for this Director role at the 6-month mark?" | Classic closing question — defines the actual mandate. |
| "How does this role partner with the credentialing and compliance teams day to day?" | Shows you understand the cross-functional nature of the work, which is central to the JD. |
The single most important thing you will say in this interview
"I want to be direct — I've built this exact function before, and I'm excited about doing it again with the technology Oscar has. Is there anything that would prevent you from extending an offer?"
Then stop. Let them answer. This surfaces any remaining objection while you're still in the room to address it.
The Night Before
- Review key numbers: <60% to 90% (2020) to 99%+ (2022) accuracy, $53M budget, 400 colleagues/1.8M+ providers, $3.5M favorable variance, 16.5→9.5 day turnaround
- Review the 4 anchor themes — practice the "right-sized scope, by choice" answer out loud
- Refresh on NCQA credentialing basics and No Surprises Act provider directory requirements
- Practice the salary script and the closing question until natural
- Print 3–4 clean resumes; confirm hybrid office address/logistics if in-person
Within 2 Hours After
- Send individual thank-you emails to each interviewer — reference something specific they said
- Send LinkedIn connection requests with a personal note
- Log any new intel (team structure, tech stack maturity, open concerns) for your next-round prep
- If verbal offer: "I'm very excited. Can I have 24 hours to review the written offer?" Don't negotiate verbally.
No matches found in this brief.