Remote Senior SIU Investigator: Fraud & W&A Analytics

Oscar Health; Athens (GA); Remote; USD 72,000 - 95,000; Full time

Benefits offered by this job

Unlimited vacation program

Annual performance bonuses

Medical, dental, and vision benefits

11 paid holidays

Paid sick time

401(k) plan participation

Life and disability insurance

Paid wellness time and reimbursements

Job summary

Oscar Health is hiring a Senior Analyst, SIU Investigator to detect and investigate aberrant claims and enrollment data within a high-autonomy role. You will manage cases from identification to resolution, including overpayment recovery and measurable savings, reporting to the SIU Investigations Manager.

The position is remote and open to candidates in AZ, FL, GA, or TX. Base pay ranges from $72,036 to $94,547 per year, with benefits and annual bonuses.

Qualifications

• 3+ years of insurance claims investigation experience or related law enforcement experience.
• 1+ year experience with fraud statutes, regulations, and federal recoupment guidelines.

Responsibilities

• Identify and investigate known or suspected FWA with high autonomy.
• Document findings with formal reports, graphs, audit logs, and supporting materials.
• Meet targets for FWA recoupments and savings through investigations and process improvements.
• Analyze prior cases to inform preventive edits and prepayment activity.
• Contribute to FWA education for Oscar teams.
• Ensure compliance with applicable laws and regulations.
• Perform other duties as assigned.

Education

Bachelor's degree in Criminal Justice or related field

Job description

Oscar Health is hiring a Senior Analyst, SIU Investigator to detect and investigate aberrant claims and enrollment data within a high-autonomy role. You will manage cases from identification to resolution, including overpayment recovery and measurable savings, reporting to the SIU Investigations Manager.

The position is remote and open to candidates in AZ, FL, GA, or TX. Base pay ranges from $72,036 to $94,547 per year, with benefits and annual bonuses.