SIU Investigator, Fraud Analyst
2 days ago
The SIU Investigator, Senior Analyst will be responsible for investigating changes in aberrant behavior observed in claims and enrollment data. This role requires strong analytical skills and the ability to work independently to identify and resolve issues.
Key Responsibilities- 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 targets through investigations and internal process improvements for FWA recoupments and savings
- Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings
- Participate in the development and presentation of FWA-related education for Oscar teams
- Perform coding reviews for flagged claims, to support Coding team
- Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies
- Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
- Experience handling confidential information and following policies, rules, and regulations
- Bonus Points: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML and Fraud Professional (CAFP), or similar
Oscar Health is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture, and our mission. We offer a competitive salary, employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.
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Insurance Fraud Investigator
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Los Angeles, California, United States ORIGIN Careers Full time{"title": "Insurance Fraud Investigator", "content": "Investigate Insurance Claims with OriginAt Origin, we're seeking a skilled Insurance Fraud Investigator to join our team. As an Investigator, you'll be responsible for conducting thorough investigations into suspected fraudulent insurance claims. Your expertise will help us identify and prevent fraudulent...
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Fraud Investigation Specialist
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Special Investigative Unit Investigator
1 week ago
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Manager of Fraud Prevention Strategies
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Fraud Quality Review Specialist
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Investigator Supervisor
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Senior Investigator
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Criminal Investigation Specialist
2 weeks ago
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Security Investigator
5 days ago
Los Angeles, California, United States Amazon Full timeJob SummaryAmazon Corporate Security is seeking an experienced Security Investigator to join its Prototype Security team. As a key member of the team, you will be responsible for developing, implementing, and leading security projects and programs to support Amazon's prototype device teams.About the RoleThis position will provide security investigation...
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Retail Security Investigator
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