About the company
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members.
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 targets through investigations and internal process improvements for FWA recoupments and savings
- Perform analysis on prior cases to inform future identification of similar claims or cases and associated savings
- Participate in the development and presentation of FWA-related education for Oscar teams
- Compliance with all applicable laws and regulations
- Other duties as assigned
Requirements
- 3+ years of insurance claims investigation experience or professional investigation experience with law enforcement agencies
- 1+ year experience with applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
- Bonus: Bachelor's degree in Criminal Justice or a related field
- Bonus: Experience working in health insurance across several product lines specifically with claims processing, billing, reimbursement, or provider contracting
- Bonus: Experience with HIPAA, data privacy, and/or data security processes
- Bonus: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML and Fraud Professional (CAFP), or similar
- Bonus: Certified Professional Coder (CPC) or similar
Conditions
- Remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas
- Occasional travel may be required for team meetings and company events
- Base pay: $72,036 - $94,547 per year
- Eligible for employee benefits, unlimited vacation program and annual performance bonuses
- Must be currently authorized to work in the United States on a full-time basis