Senior SIU Investigator – Remote Fraud & Claims Analysis

Oscar Health; Clifton (TX); Remote; USD 72,000 - 95,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonus

Medical, dental, and vision benefits

Job summary

Oscar Health is hiring a Senior Analyst, SIU Investigator to join our Special Investigations Unit. You will detect, investigate, and drive change in aberrant behavior observed in claims and enrollment data, managing investigative caseload from identification through resolution.

This remote role supports teams across AZ, FL, GA, TX, with occasional travel. Base pay $72,036–$94,547 per year plus benefits, unlimited vacation, and annual performance bonuses.

Qualifications

• 3+ years of insurance claims investigation experience or related investigative work.
• 1+ year knowledge of fraud statutes and regulations, and of federal guidelines on recoupments and anti-FWA activity.
• Experience with HIPAA, data privacy, and data security processes.

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.

Skills

Investigations

Data analysis

FWA knowledge

Education

Bachelor’s degree in Criminal Justice or related field

Job description

Oscar Health is hiring a Senior Analyst, SIU Investigator to join our Special Investigations Unit. You will detect, investigate, and drive change in aberrant behavior observed in claims and enrollment data, managing investigative caseload from identification through resolution.

This remote role supports teams across AZ, FL, GA, TX, with occasional travel. Base pay $72,036–$94,547 per year plus benefits, unlimited vacation, and annual performance bonuses.