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Role Description

Hi, we're Oscar. We're hiring a SIU Investigator to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

The SIU Investigator identifies and investigates aberrant behavior observed in medical claims data and member enrollment data. You will manage an investigative caseload from case identification through to resolution, including:

• Data mining
• Investigation planning
• Data analysis
• Sampling
• Medical records requests
• Audit interpretation
• Overpayment recovery
• Reporting to regulatory agencies
• Monitoring ongoing provider behavior

The Senior Analyst will meet metrics set forth related to caseload, turnaround times, and other unit-wide goals. You will report into the Investigations Manager, SIU.

Work Location: This is a remote position, open to candidates who reside in:

• Arizona
• Florida
• Georgia
• Illinois
• Iowa
• Kansas
• Michigan
• Missouri
• Nebraska
• New Jersey
• New York
• North Carolina
• Ohio
• Pennsylvania
• South Carolina
• Tennessee
• Texas
• Virginia

You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. If you live within commutable distance to our New York City office (in Hudson Square) or our Tempe office (off the 101 at University Ave), you will be expected to come into the office at least three days each week. Otherwise, this is a remote/work-from-home role. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule.

The base pay for this role in the states of New Jersey and New York is: $72,036 - $94,546 per year. The base pay for this role in all other locations is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Qualifications

• 3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies
• 3+ years experience with applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity

Requirements

• Bonus points:
• Bachelor's degree in Criminal Justice or a related field
• Experience with HIPAA, data privacy, and/or data security processes
• Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar
• Certified Professional Coder (CPC) or similar

Benefits

• Employee benefits including medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance
• Paid wellness time and reimbursements