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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 aberrant behavior observed in claims and enrollment data. This role is central to Oscar's fraud, waste, and abuse (FWA) prevention efforts.
You will analyze claims and enrollment data to identify suspicious patterns, manage investigative caseloads from identification through resolution, and drive overpayment recovery and behavior change. Responsibilities include conducting high-autonomy investigations into known or suspected FWA; developing substantiating documentation (formal reports, graphs, audit logs); meeting FWA recoupment and savings targets through investigations and process improvements; performing retrospective analysis on prior cases to inform preventive strategies; and participating in FWA education for Oscar teams. You will report to the Investigations Manager, SIU.
Occasional travel may be required for team meetings and company events. This is a full-time remote position open to candidates residing in Arizona, Florida, Georgia, or Texas.
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
