Senior Analyst, SIU Investigator

The role

The Senior Analyst, SIU Investigator detects, investigates, and produces change in aberrant behavior observed in claims and enrollment data. You will manage investigative caseloads from identification to resolution and perform analysis to improve FWA recoupments and savings.

What you will do

• 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
• Participate in the development and presentation of FWA-related education for Oscar teams
• Compliance with all applicable laws and regulations
• Other duties as assigned

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
• Must be currently authorized to work in the United States on a full-time basis

Nice to have

• Bachelor's degree in Criminal Justice or a related field
• Experience working in health insurance across several product lines specifically with claims processing, billing, reimbursement, or provider contracting
• Experience with HIPAA, data privacy, and/or data security processes
• Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar
• Certified Professional Coder (CPC) or similar

Benefits

• Medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance
• Paid wellness time and reimbursements
• Unlimited vacation program
• Annual performance bonuses

Before you apply

• Must be currently authorized to work in the United States on a full-time basis
• Oscar will not sponsor applicants for this role

About the company

Oscar is a health insurance company built around a full stack technology platform. It was started in 2012 to create a health insurance company that behaves like a doctor in the family.