Senior Analyst, SIU Investigator

This is a fully remote position, open to applicants in United States.

📋 Description

• Identify and carry out investigations into known or suspected instances of Fraud, Waste, and Abuse with a high degree of autonomy.

• Create documentation to support findings, which includes formal reports, graphs, audit logs, and other supporting materials.

• Achieve targets through investigations and enhancements of internal processes related to FWA recoupments and savings.

• Examine previous cases to guide the future identification of similar claims or cases and their associated savings.

• Assist in transitioning from a “pay-and-chase” model to preventive edits and prepayment activities.

• Engage in the creation and delivery of FWA-related educational content for Oscar teams.

• Adhere to all relevant laws and regulations.

• Perform additional duties as assigned.

• Report directly to the Investigations Manager, SIU.

⛳️ Requirements

• A minimum of 3 years of experience in insurance claims investigation or professional investigation experience with law enforcement entities.

• At least 1 year of experience with relevant fraud statutes and regulations, as well as federal guidelines regarding recoupments and other anti-FWA efforts.

• Must currently possess authorization to work in the United States on a full-time basis.

• Oscar does not sponsor applicants for this position.

• A Bachelor's degree in Criminal Justice or a related field is preferred (bonus point).

• Experience in health insurance across various product lines, particularly in claims processing, billing, reimbursement, or provider contracting (bonus point).

• Familiarity with HIPAA, data privacy, and/or data security processes (bonus point).

• Possession of certifications such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML and Fraud Professional (CAFP), or similar (bonus point).

• Certified Professional Coder (CPC) or a similar certification (bonus point).

🏝️ Benefits

• Employee benefits.

• Unlimited vacation program.

• Annual performance bonuses.

• Medical, dental, and vision benefits.

• 11 paid holidays.

• Paid sick time.

• Paid parental leave.

• Participation in a 401(k) plan.

• Life and disability insurance.

• Paid wellness time and reimbursements.

• Occasional travel for team meetings and company events.