Senior Specialist, Provider Data Operations (US Healthcare Insurance)

Overview

As an Insurance Specialist, you will use your knowledge of the U.S. healthcare insurance landscape to help Zocdoc make sound, scalable decisions that improve how patients find in-network care. This cross-functional role works with Product, Operations, Engineering, and Data & Analytics to frame problems, evaluate options, align stakeholders, and turn insights into requirements and measurable improvements.

What you'll do

• Own the policies governing insurance carriers and plans across the Zocdoc marketplace, including rules for adding, modifying, and removing carriers and plans and thresholds for performance-based retention or removal.
• Stay informed about developments in the U.S. health insurance landscape, including new carrier launches, plan introductions, mergers, and regulatory changes, and evaluate their impact on Zocdoc's insurance database.
• Partner with Product, Engineering, Operations, and Data & Analytics teams to ensure insurance taxonomies support product strategy and accurate patient search experiences.
• Translate complex insurance policies into clear product requirements, data models, business rules, and acceptance criteria.
• Advise senior Operations, Product, and Engineering leaders on recommendations and tradeoffs, influence roadmap priorities, and shape taxonomy architecture, validation logic, tooling, and system controls.
• Define reporting and monitor performance, and lead incident reviews and escalations involving inaccurate insurance availability or provider matching to identify root causes and mitigate future risk.
• Define, monitor, and report on key insurance database health metrics, and conduct regular reviews with Product, Operations, and Data partners to identify trends and prioritize improvements.
• Identify systemic issues affecting insurance data quality and lead continuous improvement initiatives.
• Refine policies and operational processes to improve efficiency, reduce manual effort, and increase accuracy across workflows.
• Act as the organization's expert on U.S. health insurance, review and validate outputs from operational teams for new plan additions and complex taxonomy decisions, and serve as the final escalation point for policy interpretation and insurance-related quality questions.

What you'll need

• Bachelor's degree from a reputed institution with a strong academic record.
• 5+ years of experience in the U.S. healthcare industry, with deep expertise in Insurance Payor Management, Payor Analytics, Database Management, or related functions at payor or plan level.
• Strong understanding of U.S. commercial insurance plans, carriers, and provider networks.
• Strong analytical mindset with experience using metrics and data to drive strategic decisions and operational improvements.
• Experience partnering cross-functionally with Product, Operations, Analytics, and Engineering teams to deliver scalable solutions.
• Excellent problem-solving skills with the ability to balance strategic thinking and operational execution.
• Excellent verbal and written communication skills in English.
• Strong attention to detail and ability to influence stakeholders across functions.
• Experience with SQL, Excel, Google Sheets, Looker, or other analytical tools is a must.
• Familiarity and proven usage of AI-driven tools and workflow automation is a must.

Details

• Location: Pune, Maharashtra, India.