Senior SIU Investigator – Remote

Oscar Health; Lorida (FL); Remote; USD 72,000 - 95,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonus

Medical, dental, vision benefits

Job summary

Oscar Health is seeking a Senior Analyst, SIU Investigator to join our SIU team in a remote capacity. You will detect, investigate, and report on fraud, waste and abuse in claims and enrollment data, managing investigations from identification to resolution.

You will analyze data, drive improvements, and support prevention edits and prepayment activity while ensuring compliance with applicable laws. US work authorization required.

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 for FWA recoupments and savings.
• Perform analysis on prior cases to inform future identification of similar claims or cases and associated savings.
• 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

Investigation experience

Data analysis

Fraud awareness

Education

Bachelor's degree in Criminal Justice

Job description

Oscar Health is seeking a Senior Analyst, SIU Investigator to join our SIU team in a remote capacity. You will detect, investigate, and report on fraud, waste and abuse in claims and enrollment data, managing investigations from identification to resolution.

You will analyze data, drive improvements, and support prevention edits and prepayment activity while ensuring compliance with applicable laws. US work authorization required.