Senior Analyst, SIU Investigator

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Quick Summary

Key Responsibilities

Identify and conduct investigations into known or suspected FWA with high autonomy Develop documentation to substantiate findings, including formal reports, graphs, audit logs,

Requirements Summary

3+ years of insurance claims investigation experience or professional investigation experience with law enforcement agencies 1+ year experience with applicable fraud statutes and regulations,

Technical Tools

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Hi, we're Oscar. We're hiring a Senior Analyst, SIU Investigator to join our SIU 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

~1 min read

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.

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

Responsibilities

~1 min read

→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

~1 min read

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

Nice to Have

~2 min read

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.

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.

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