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Investigative Sr. Analyst, SIU

Oscar Los Angeles, CA
  • Posted: over a month ago
  • Full-Time
Job Description

Hi, we're Oscar. We're hiring an Investigative Sr. Analyst to join our SIU team in our Los Angeles office. 

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 and headquartered in New York City. Our goal is to make health insurance simple, transparent, and human. We need your help to do so.

About the role:

The SIU runs or coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. 

Within the SIU, your primary role will be to support Oscar in its fight against fraud.  Joining this dynamic team will expose you to the latest trends and patterns in FWA across the healthcare industry – and provide you with the chance to fight this FWA using sophisticated analytical tools and big data.  Your work will not only lead to savings and recoupments for Oscar as a company, but to more affordable and higher-quality health care for the members we serve.

You will report into the SIU Director, who reports to the Compliance Officer.

Responsibilities:

  • Develop and expand your knowledge of FWA trends and schemes to efficiently intake and evaluate reports of FWA received by the SIU.  Review data and gather evidence to assign priority levels, assess reporting obligations based on state(s) impacted, and maintain a pipeline of investigations into known or suspected FWA to be assigned to the investigators.
  • Coordinate and fulfill responses to Requests for Information (RFI), Subpoenas, Regulators, and internally received within the SIU.
  • Coordinate and complete assigned annual reportings and filings ensuring required responses are received within deadlines.
  • Conduct preliminary investigations of out of network providers, including reviewing data, building a case file, gathering evidence, and recommending next steps.
  • Provide support to investigators as requested to include performing interviews of members and contacting providers.
  • Gather and prepare reporting as assigned for internal use.

Requirements:

  • Bachelor's degree in Criminal Justice, Business or similar
  • 2+ years of health insurance experience
  • Experience handling confidential information and adhering to policies, rules, and regulations
  • Highly organized with a high level of attention to detail
  • Enjoy complex problem solving and are willing to consider multiple possible solutions or causes.

Bonus points:

  • Certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), Certified Professional Coder (CPC) or similar
  • Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
  • Experience specifically with claims processing, billing, reimbursement, or provider contracting.
  • Experience with HIPAA, data privacy, and/or data security processes
  • Experience working with regulators governing (public or private) health insurance carriers

Life at Oscar: 

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

We encourage our members to care for their whole selves, and we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

Reasonable Accommodation:

Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

Pay Transparency Policy:

Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

Oscar

Address

Los Angeles, CA
USA

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