SIU Investigator
About The Position
The Senior Analyst, 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 and monitoring ongoing provider behavior. The Senior Analyst will meet metrics set forth related to caseload, turn around 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; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role 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.
Requirements
- 3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies
- 3+ year experience with applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
Nice To Haves
- 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
Responsibilities
- Identify and conduct investigations into suspected FWA with high autonomy
- Document findings to include formal investigative reports, tables, graphs, audit logs, and other supporting documentation
- Met metrics to align with caseload, turn around times, and other unit-wide goals
- Continue to monitor providers with substantiated findings to track behavior change
- Participate in the development and presentation of FWA-related education for Oscar teams
- Build evidentiary files for potential recovery, legal action, and/or referrals to appropriate outside agencies
- Compliance with all applicable laws and regulations
- Other duties as assigned
Benefits
- employee benefits
- participation in Oscar's 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
