SIU Investigator

11 hours, 5 minutes ago
Full-time
Mid Level
Operations
Oscar

Oscar

Oscar is a health insurance company that offers plans for individuals, families, and small businesses. With a focus on humanizing health care through technology, design, and data, Oscar provides easy-to-understand bills, 24/7 access to doctors, and a p...

Insurance
1K-5K
Founded 2012

Description

  • Identify and conduct investigations into suspected fraud, waste, and abuse with high autonomy.
  • Manage an investigative caseload from case identification through resolution.
  • Perform data mining, investigation planning, data analysis, and sampling to support investigations.
  • Request and review medical records and interpret audit findings.
  • Document findings in formal investigative reports, tables, graphs, audit logs, and supporting materials.
  • Build evidentiary files for potential recovery, legal action, and referrals to outside agencies.
  • Monitor providers with substantiated findings to track behavior change over time.
  • Report findings to regulatory agencies as required and ensure compliance with applicable laws and regulations.
  • Participate in the development and presentation of fraud, waste, and abuse education for Oscar teams.
  • Meet caseload, turnaround time, and unit-wide performance metrics.

Requirements

  • 3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies.
  • 3+ years of experience with applicable fraud statutes and regulations, including federal guidelines on recoupments and anti-fraud, waste, and abuse activity.
  • Bachelor's degree in Criminal Justice or a related field (preferred).
  • Experience with HIPAA, data privacy, and/or data security processes (preferred).
  • Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML and Fraud Professional (CAFP), or similar certification (preferred).
  • Certified Professional Coder (CPC) or similar certification (preferred).

Benefits

  • Remote work for candidates residing in eligible states, with a hybrid option for those near the New York City or Tempe office.
  • Base salary of $64,832-$85,092 in most locations or $72,036-$94,546 in New Jersey and New York.
  • Eligibility for employee benefits.
  • Unlimited vacation program.
  • Annual performance bonuses.
  • Medical, dental, and vision insurance.
  • 11 paid holidays, paid sick time, paid parental leave, and paid wellness time.
  • 401(k) plan participation, life and disability insurance, and wellness reimbursements.

Interested in this position?

Apply directly on the company website

Apply Now

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