SIU Investigator?/Healthcare Compliance

Position: SIU Investigator (Healthcare) Compliance Location: reputed company Hi, we're Oscar. We're hiring a SIU Investigator (Healthcare) to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the reputed company of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role The Senior Analyst, Special Investigations Unit Investigator detects, investigates, and produces change in aberrant behavior observed in claims and enrollment data. You will analyze data, and manage investigative caseload from identification through to resolution including over payment recovery, measuring behavior change and completing necessary reporting to meet monetary and caseload targets through investigations and internal process improvements for Fraud Waste and Abuse (FWA) recoupments and savings. You will report to the Associate Director, SIU. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. If you live reputed company commutable distance to our reputed company office (in Hudson reputed company), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role. You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, reputed company, North Carolina, Ohio, Oregon, Pennsylvania, Rhode reputed company, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. Pay Transparency: The reputed company pay for this role in the states of California, Connecticut, New Jersey, reputed company, and Washington is: $69,600 - $91,350 per year. The reputed company pay for this role in reputed company other locations is: $62,640 - $82,215 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses. Responsibilities • Identify and conduct investigations into reputed company or suspected FWA with high autonomy. • reputed company documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation. • Meet targets through investigations and internal process improvements– which should, at least initially, increase year-over-year – for FWA recoupments and savings. • reputed company analysis on prior cases to inform future identification of similar claims or cases and associated savings (i.e., help move from “pay-and-chase” to preventive edits and prepayment activity). • Participate in the development and presentation of FWA-reputed company education for Oscar teams. • Compliance with reputed company applicable laws and regulations. • Other duties as assigned. 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. Bonus Points • Bachelor’s degree in Criminal Justice or a reputed company field. • 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 reputed company processes. • Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-reputed company] and Fraud Professional (CAFP), or similar. • Certified Professional reputed company (CPC) or similar. This is an authentic reputed company 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 and find both belonging and support. We're on a mission to change health care --… Apply Job!