Senior Analyst, SIU InvestigatorActive$72K–$95K

Oscar Health
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The opportunity

Hi, we're Oscar. We're hiring a Senior Analyst, SIU Investigator to join our SIU team.

What you'll 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: which should, at least initially, increase year-over-year – for FWA recoupments and savings

  • Perform 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-related education for Oscar teams

  • Compliance with all applicable laws and regulations

What they're looking for

  • Other duties as assigned
  • + years of insurance claims investigation experience or professional: investigation experience with law enforcement agencies
  • + year experience with applicable fraud statutes and regulations, and of: federal guidelines on recoupments and other anti-FWA activity
  • Bachelor's degree in Criminal Justice or a related field