Hi, we're Oscar. We're hiring a Senior Analyst, SIU Investigator to join our SIU team.
About the role:The Senior Analyst, Special Investigations Unit Investigator detects, investigates, and produces change in aberrant behavior observed in claims and enrollment data. You will analyze data and manage investigative caseload from identification through to resolution including overpayment recovery, measuring behavior change and completing necessary reporting to meet monetary and caseload targets through investigations and internal process improvements for Fraud Waste and Abuse (FWA) recoupments and savings.
You will report into the Investigations Manager, SIU.
Work Location:This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote
Pay Transparency: The base pay for this role is: $72,036 - $94,547 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
You must be currently authorized to work in the United States on a full-time basis. Oscar will not sponsor applicants for this role.
Responsibilities:- Identify and conduct investigations into known or suspected FWA with high autonomy
- Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation.
- Meet targets through investigations and internal process improvements- which should, at least initially, increase year-over-year - for FWA recoupments and savings
- Perform analysis on prior cases to inform future identification of similar claims or cases and associated savings (i.e., help move from "pay-and-chase" to preventive edits and prepayment activity)
- Participate in the development and presentation of FWA-related education for Oscar teams
- Compliance with all applicable laws and regulations
- Other duties as assigned
Requirements:- 3+ years of insurance claims investigation experience or professional investigation experience with law enforcement agencies
- 1+ year experience with applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
Bonus points:- Bachelor's degree in Criminal Justice or a related field
- Experience working in health insurance across several product lines specifically with claims processing, billing, reimbursement, or provider contracting.
- Experience with HIPAA, data privacy, and/or data security processes
- Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar
- Certified Professional Coder (CPC) or similar
This is an authentic Oscar Health job opportunity.
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.
