Hi, we're Oscar. Were hiring a Senior FWA Diagnostic Analyst to join our SIU Team.
Oscar is the first health insurance company built around a full stack technology platform & a relentless 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 runs or coordinates activities across Oscar to reduce the incidence & impact of fraud, waste, and/or abuse (FWA) on all our operations.
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 by improving the process & efficiencies of the work performed by the SIU team. Your work will not only lead to increased savings & recoupments for Oscar as a company, but to more affordable & higher-quality health care for the members we serve.
You will report to the Lead Investigator, who reports to the Director, SIU.
This is a remote role, you will work remotely in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.
Independently work through an assigned queue of unresolved Internal & External waste opportunities & bring them to resolution.
Research the root cause of the issue & determine the appropriate method of correction.
Initiate adjustments of the claims & initiate recovery efforts including offset (if allowed by contract/state).
Monitor recoveries as appropriate & escalate if necessary. Ensure recoveries are reported as required to enable accurate tracking & reporting
Track trending causes of waste to identify themes. Escalate repetitive issues to be corrected or mitigated.
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), other coding or billing certifications or similar
Knowledge of applicable state & federal fraud statutes & regulations, as well as guidelines on recoupments & other anti-FWA activity
Experience working in health insurance specifically with claims processing, billing, reimbursement, provider contracting, or enrollment.
Exposure to claims processing systems
Experience with HIPAA, data privacy, and/or data security processes
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.
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 (firstname.lastname@example.org) 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.
COVID-19 vaccine requirements for in-person work:
To protect the health & safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date.
If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at email@example.com to submit an accommodations request.
*Note: In-person work includes: employees required to work from our offices (either full-time or part-time), employees conducting sales work in the field & employees conducting at-home or in-person visits with members.