Senior Analyst, SIU Investigator

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $64.8k - $94.5k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

💰 $355M Post-IPO Debt - Oscar Health on 2025-09

Healthcare Insurance • Healthcare

Oscar Health is a technology-driven health insurance company that provides individual, family, and small-group health plans in multiple U. S. states. Oscar combines traditional insurance underwriting with digital-first services — a consumer-facing app, 24/7 virtual urgent care, prescription delivery (including $3 meds in many plans), and dedicated Care Teams — and also operates Oscar Primary Care in some markets. The company emphasizes accessible, affordable, high-quality care and uses AI to improve member experience and care delivery. Insurance policies are underwritten by Oscar's state insurance subsidiaries and the company offers both HMO and other plan types across its markets.

📋 Description

• Identify and conduct investigations into known or suspected Fraud, Waste, and Abuse with high autonomy • Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and supporting documentation • Meet targets through investigations and internal process improvements for FWA recoupments and savings • Analyze prior cases to inform future identification of similar claims or cases and associated savings • 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 • Comply with all applicable laws and regulations • Perform other duties as assigned • Report to the Investigations Manager, SIU

🎯 Requirements

• 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 • Must be currently authorized to work in the United States on a full-time basis • Oscar will not sponsor applicants for this role • Bachelor's degree in Criminal Justice or a related field (bonus point) • Experience working in health insurance across several product lines, specifically with claims processing, billing, reimbursement, or provider contracting (bonus point) • Experience with HIPAA, data privacy, and/or data security processes (bonus point) • Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML and Fraud Professional (CAFP), or similar (bonus point) • Certified Professional Coder (CPC) or similar (bonus point)

🏖️ Benefits

• Employee benefits • Unlimited vacation program • Annual performance bonuses • 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 • Occasional travel for team meetings and company events