Senior Analyst, SIU Investigator

Oscar Health•New York, NY

3d•$64,832 - $94,547•Remote

About The Position

Oscar is hiring a Senior Analyst, SIU Investigator to join its Special Investigations Unit (SIU). The role detects, investigates, and addresses aberrant behavior found in claims and enrollment data. The investigator analyzes data and manages investigative cases from identification through resolution, including overpayment recovery, measurement of behavior change, and required reporting. The work supports monetary and caseload targets through investigations and internal process improvements related to Fraud, Waste, and Abuse (FWA) recoupments and savings. The position reports to the Investigations Manager, SIU. It is fully remote for candidates residing in the U.S., excluding Alaska, Delaware, Hawaii, Louisiana, Montana, North Dakota, Oklahoma, West Virginia, Wyoming, and U.S. Territories. Work is performed from a home office, with occasional travel for team meetings and company events. Applicants must be authorized to work in the United States on a full-time basis; Oscar will not sponsor applicants. Base pay is $72,036–$94,547 per year in California, Connecticut, New Jersey, New York, and Washington, and $64,832–$85,093 per year in other locations. The role is eligible for employee benefits, Oscar's unlimited vacation program, and annual performance bonuses. Final offers within the stated ranges depend on relevant skills, education, and experience.

Requirements

At least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies.
At least 1 year of experience with applicable fraud statutes and regulations, and federal guidelines on recoupments and other anti-FWA activity.
Current authorization to work in the United States on a full-time basis; Oscar will not sponsor applicants.

Nice To Haves

Bachelor's degree in Criminal Justice or a related field.
Experience working in health insurance across several product lines, specifically with claims processing, billing, reimbursement, or provider contracting.
Experience with HIPAA, data privacy, and/or data security processes.
Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML and Fraud Professional (CAFP), or similar certification.
Certified Professional Coder (CPC) or similar certification.

Responsibilities

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 investigation and internal process-improvement targets for FWA recoupments and savings, which should initially increase year over year.
Analyze prior cases to inform future identification of similar claims or cases and associated savings, helping move from pay-and-chase toward preventive edits and prepayment activity.
Participate in developing and presenting FWA-related education for Oscar teams.
Comply with all applicable laws and regulations.
Perform other duties as assigned.