Remote SIU Investigator — Fraud, Waste & Abuse

Oscar Health; Texas; Remote; USD 72,000 - 95,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonuses

Job summary

Oscar Health is seeking a Senior Analyst for the SIU Investigator role, focusing on detecting and resolving aberrant claims and enrollment activity. You will manage caseloads, drive overpayment recovery, and contribute to process improvements for fraud, waste, and abuse savings.

You will report to the Investigations Manager, SIU. The position is remote and open to several US states, including Texas, with potential travel for meetings and events.

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., help move from 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

Education

Bachelor's degree in Criminal Justice

Job description

Oscar Health is seeking a Senior Analyst for the SIU Investigator role, focusing on detecting and resolving aberrant claims and enrollment activity. You will manage caseloads, drive overpayment recovery, and contribute to process improvements for fraud, waste, and abuse savings.

You will report to the Investigations Manager, SIU. The position is remote and open to several US states, including Texas, with potential travel for meetings and events.