Remote SIU Investigator - Fraud & Abuse Analytics Lead

Oscar Health; Phoenix (AZ); Remote; USD 72,000 - 95,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonuses

Job summary

Oscar Health is hiring a Senior Analyst, Special Investigations Unit Investigator to detect, investigate, and drive changes in aberrant claims and enrollment data. You will manage a caseload from identification to resolution, aiming for recoupments and savings through process improvements.

The role is remote, open to residents of AZ, FL, GA, or TX, with occasional travel for meetings and events. Base pay ranges from $72,036 to $94,547 yearly, plus benefits and performance bonuses.

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 anti-FWA activity.

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 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., 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

Skills

Investigations

Data analysis

Caseload management

Education

Bachelor's degree in Criminal Justice or related field

Job description

Oscar Health is hiring a Senior Analyst, Special Investigations Unit Investigator to detect, investigate, and drive changes in aberrant claims and enrollment data. You will manage a caseload from identification to resolution, aiming for recoupments and savings through process improvements.

The role is remote, open to residents of AZ, FL, GA, or TX, with occasional travel for meetings and events. Base pay ranges from $72,036 to $94,547 yearly, plus benefits and performance bonuses.