SIU Investigator Senior Analyst
SIU Investigator Senior Analyst
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$ 69120 - 82080
1 Vacancy
Job Description
Hi were Oscar. Were hiring a SIU Investigator Sr. Analyst 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 Senior Analyst Special Investigations Unit Investigator investigates 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 to the Senior Investigator 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 Ave) 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 Idaho 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 Washington D.C. or Wisconsin. 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: $76800 $91200 per year. The base pay for this role in all other locations is: $69120 $82080 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program and annual performance bonuses.
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 yearoveryear 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 payandchase to preventive edits and prepayment activity)
- Participate in the development and presentation of FWArelated education for Oscar teams
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- 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 antiFWA activity
Bonus Points
- Bachelors degree in Criminal Justice or a related field
- Experience working in health insurance across several products 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 AntiMoney Laundering and Fraud Professional (CAFP) or similar
- Certified Professional Coder (CPC) or similar
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:
Senior IC
Employment Type
Full-Time
