Senior SIU Investigator - Remote Fraud & Savings Driver

Oscar Health; Yuma (AZ); A distancia; USD 72.000 - 95.000; Jornada completa

Descripción de la vacante

Oscar Health is seeking a Senior Analyst, SIU Investigator to join the SIU team. This remote role reports to the Investigations Manager and focuses on detecting, investigating, and recouping FWA in claims and enrollment data.

The ideal candidate has 3+ years in insurance investigations, knowledge of fraud statutes, and health-insurance experience, with bonus points for relevant certifications. US work authorization required.

Formación

• 3+ years in insurance claims investigations or law enforcement investigations.
• 1+ year experience with fraud statutes and federal recoupment guidelines.
• Experience in health insurance claims processing, billing, reimbursement or contracting.
• Familiarity with HIPAA, data privacy, and data security processes.

Responsabilidades

• Identify and conduct investigations into known or suspected FWA with high autonomy
• Develop documentation to substantiate findings, including reports and graphs
• Meet targets through investigations and process improvements for FWA recoupments and savings
• Analyze prior cases to inform future prevention edits and prepayment activity
• Present FWA-related education for Oscar teams
• Ensure compliance with applicable laws and regulations
• Other duties as assigned

Conocimientos

Claims investigation

FWA investigations

HIPAA / data privacy

Health insurance experience

Documentation & reporting

Analytical thinking

Educación

Bachelor's in Criminal Justice or related field

CFE / AHFI / CAFP or equivalent

CPC or similar

Descripción del empleo

Oscar Health is seeking a Senior Analyst, SIU Investigator to join the SIU team. This remote role reports to the Investigations Manager and focuses on detecting, investigating, and recouping FWA in claims and enrollment data.

The ideal candidate has 3+ years in insurance investigations, knowledge of fraud statutes, and health-insurance experience, with bonus points for relevant certifications. US work authorization required.