Associate Director Special Investigations Unit
Associate Director Special Investigations Unit
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$ 144000 - 189000
1 Vacancy
Job Description
Hi were Oscar. Were hiring a Associate Director Special Investigations Unit to join our SIU team.
Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.
About the role
The Associate Director Special Investigations Unit role oversees the development and management of SIU programs conducting prepay and postpayment investigations to detect and eliminate potential fraud waste and abuse (FWA). Leading people leaders and individual contributors the Associate Director is tasked with the development of strategies for crossfunctional detection and mitigation of FWA; creation of departmental processes aimed at evaluating Metrics and progress towards established goals ensuring appropriate procedures are in place to develop a successful SIU program.
You will report to the Director SIU.
Work Location:
Oscar is a blended work culture where everyone regardless of work type or location feels connected to their teammates our culture and our mission.
If you live within commutable distance to our New York City office (in Hudson Square) our Tempe office (off the 101 at University Dr) or our Los Angeles office (in Marina Del Rey) you will be expected to come into the office at least two days each week. Otherwise this is a remote / workfromhome role.
You must reside in one of the following states: Alabama Arizona Arkansas California Colorado Connecticut Florida Georgia Illinois Indiana Iowa Kansas Kentucky Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico New York North Carolina Ohio Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Vermont Virginia Washington or Washington D.C. Note this list of states is subject to change. #LIRemote
Pay Transparency:
The base pay for this role in the states of California Connecticut New Jersey New York and Washington is: $144000 $189000 per year. The base pay for this role in all other locations is: $129600 $170100 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program and annual performance bonuses.
Responsibilities
- Support the Director to develop procedures fraud waste and abuse plans annual audit work plans department guidance memos and training and educational materials for internal and external recipients. Help evaluate the effectiveness of existing processes and make recommendations for improvements including system enhancements to enhance outcomes and performance.
- Develop relationships with departmental leaders to understand and influence business operations work collaboratively and crossfunctionally with SIU partner departments.
- Approve metrics tracking and reporting before distribution to the Director.
- Manage SIU inventory ensuring audit and investigation steps are processed and promptly. Ensure investigations and audits progress in adherence with state and/or federal requirements.
- Help manage external engagements and related to requests from federal state and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters.
- Manage team including hiring training professional development performance management work allocation scheduling and related supervisory activities. Facilitate team meetings and may lead and represent the SIU in multiple internal or external forums including state and/or federal FWA related regulatory meetings.
- Ensure that Oscar meets its legal and regulatory obligations related to FWA; Make referrals to and maintain relationships with regulatory and law enforcement officials; Maintain current indepth knowledge of all Oscar benefits payment policies provider network configuration issues and industry billing practices.
- Compliance with all applicable laws and regulations
- Other duties as assigned.
Qualifications
- A bachelors degree in Criminal Justice or a related field OR 6 years of insurance claims investigation experience and/or professional investigation experience with law enforcement agencies OR 6 years of professional investigation experience involving economic or insurancerelated matters
- 6 years total work experience in insurance health care tech investigations and/or law enforcement
- 3 years of experience managing internal teams external delegates and crossfunctional initiatives Knowledge of applicable fraud statutes and regulations and of CMS guidelines
- Current Certified Professional Coder (CPC) certification
Bonus Points
- Certification applicable to this work i.e. Certified Fraud Examiner (CFE) Accredited Healthcare Fraud Investigator (AHFI) Certified AML AntiMoney Laundering and Fraud Professional (CAFP) other coding certifications or similar
- Knowledge of applicable fraud statutes and regulations and of federal guidelines on recoupments and other antiFWA activity
- Experience working in health insurance specifically with claims processing billing reimbursement or provider contracting.
- Experience with HIPAA data privacy and/or data security processes
- Experience working with regulators governing (public or private) health insurance carriers
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar being an Equal Opportunity Employer means more than upholding discriminationfree hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. Were 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. Fulltime 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.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications without regard to applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team to make the need for an accommodation known.
Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar.
California Residents: For information about our collection use and disclosure of applicants personal information as well as applicants rights over their personal information please see our Notice to Job Applicants.
Required Experience:
Director
Employment Type
Full-Time
