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Hi, we're Oscar. We're hiring an SIU Investigator, Sr. Analyst to join our SIU team.
Oscar is the first health insurance company built around a full stack technology platform & a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.
About the role
The SIU Investigator (Senior Analyst) primary purpose is to investigate change in aberrant behavior observed in claims & enrollment data. You will work independently to analyze data, & manage investigative caseload from identification through to resolution including overpayment recovery, measuring behavior change & completing necessary reporting to meet monetary & case load targets through investigations & internal process improvements which should, at least initially, increase year-over-year for FWA recoupments & savings.
You will report to the Senior Investigator, SIU.
Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture & our mission.
This is a hybrid role in our New York City office. You will work part of the time in the office & part of the time remote / work-from-home. #LI-Hybrid
Pay Transparency:
The base pay for this role is: $76,800 - $91,200 per year. You are also eligible for employee benefits, participation in Oscars unlimited vacation program & annual performance bonuses.
Responsibilities
- Identify & conduct investigations into known or suspected FWA with high autonomy
- Develop documentation to substantiate findings, including formal reports, graphs, audit logs, & other supporting documentation.
- Meet targets through investigations & internal process improvements which should, at least initially, increase year-over-year for FWA recoupments & savings
- Perform root cause analysis to inform future algorithmic identification of similar claims or cases & associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits & pre-payment activity)
- Participate in the development & presentation of FWA-related education for Oscar teams
- Perform coding reviews for flagged claims, to support Coding team
Qualifications
- Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies
- Knowledge of applicable fraud statutes & regulations, & of federal guidelines on recoupments & other anti-FWA activity
- Experience handling confidential information & following policies, rules, & regulations
Bonus points
- Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] & Fraud Professional (CAFP), or similar
- Certified Professional Coder (CPC) or similar
- Experience working in health insurance across several products specifically with claims processing, billing, reimbursement, or provider contracting.
- Experience with HIPAA, data privacy, and/or data security processes
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves & find both belonging & support. We're on a mission to change health care -- an experience made whole by our unique backgrounds & perspectives..
Pay Transparency:
Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, & experience.
Full-time employees are eligible for benefits including: medical, dental, & vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life & disability insurance, & paid wellness time & reimbursements.
Reasonable Accommodation:
Oscar applicants are considered solely based on their qualifications, without regard to applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
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