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Salary: USD 72,036 - 94,547 / annual
Oscar Health is seeking a Senior Analyst, Special Investigations Unit Investigator to detect, investigate, and drive change in fraudulent, wasteful, and abusive (FWA) behavior identified in claims and enrollment data. You will analyze data patterns, manage investigative caseloads from identification through resolution, and drive overpayment recovery and behavior change. Your work will directly contribute to FWA recoupment and savings targets through both investigations and internal process improvements.
Reporting to the Investigations Manager, SIU, you will have high autonomy in identifying and conducting investigations into known or suspected FWA. Key responsibilities include developing comprehensive documentation to substantiate findings (formal reports, graphs, audit logs, supporting materials), meeting FWA recoupment and savings targets, and performing retrospective analysis on prior cases to shift from reactive "pay-and-chase" approaches to preventive edits and prepayment activity. You will also participate in developing and presenting FWA-related education for Oscar teams and ensure compliance with all applicable laws and regulations.
This is a remote position open to candidates residing in Arizona, Florida, Georgia, or Texas. Occasional travel may be required for team meetings and company events.
**Requirements:**
- 3+ years of insurance claims investigation experience OR professional investigation experience with law enforcement agencies
- 1+ year of experience with applicable fraud statutes, regulations, and federal guidelines on recoupments and anti-FWA activity
**Bonus qualifications:**
- Bachelor's degree in Criminal Justice or related field
- Experience in health insurance across multiple product lines (claims processing, billing, reimbursement, provider contracting)
- Experience with HIPAA, data privacy, and/or data security processes
- Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML and Fraud Professional (CAFP), or similar certification
- Certified Professional Coder (CPC) or similar credential
