SIU Investigator, Fraud Analyst

2 days ago


Los Angeles, California, United States Oscar Health Full time
About the Role

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
Requirements
  • 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
What We Offer

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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