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Oscar Health // health insurance
 
Tempe, Arizona, United States    Posted: Wednesday, August 05, 2020
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring a Senior Investigator to join our Special Investigations Unit (SIU) in our Tempe, Arizona office.

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 & headquartered in New York City. Our goal is to make health insurance simple, transparent, & human. We need your help to do so.

About this role:

The SIU runs or coordinates activities across Oscar to reduce the incidence of fraud, waste, & abuse (FWA) on all our operations. 

Within the SIU, your primary role will be to support Oscar in its fight against fraud. Joining this dynamic team will expose you to the latest trends & patterns in FWA across the healthcare industry & provide you with the chance to fight FWA using tools & big data. Your work will not only lead to savings & recoupments for Oscar as a company, but to more affordable & higher-quality health care for the members we serve.

You will report into the SIU Director, who reports to the Compliance Officer.

Responsibilities:

  • Independently identify & work on efficient means to initiate & track investigations into known or suspected FWA, refining your process & practices to seek greater efficiency & better use of data & technology
  • Develop concise documentation to substantiate findings, including formal reports, graphs, audit logs, & other supporting documentation.
  • Set & meet targets through investigations & internal process improvements which should, at least initially, increase year-over-year for (medical & pharmacy) FWA recoupments & savings
  • Perform root cause analysis & identify trends among current fraud, waste, & abuse schemes so as 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)
  • Connect internally to support process improvement implementations resulting from investigations
  • Make referrals to, maintain relationships with, & respond to requests from regulatory & law enforcement officials
  • Create & administer FWA-related education for Oscar teams

Requirements:

  • This role, by law, requires a bachelors degree in Criminal Justice or a related field, OR five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, OR seven years of professional investigation experience involving economic or insurance-related matters
  • Knowledge of applicable fraud statutes & regulations, & of federal guidelines on recoupments & other anti-FWA activity
  • Experience handling confidential information & following policies, rules, & regulations
  • At least one certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] & Fraud Professional (CAFP), Certified Professional Coder (CPC) or similar

Bonus points:

  • Experience with HIPAA, data privacy, or data security processes
  • Experience working with regulators governing (public or private) health insurance carriers

Life at Oscar:

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.

We encourage our members to care for their whole selves, & we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.

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.

Pay Transparency Policy

Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

 
 
 
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