Senior Analyst, SIU Investigator
O
Oscar HealthHealth Insurance
Arizona, Florida, Georgia, TexasFull-TimeSenior
Salary64832 - 85092 USD per year
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Job Details
- Experience
- 3+ years
- Required Skills
- Data AnalysisData Mining
Requirements
- 3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies
- 3+ year experience with applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
- Bachelor's degree in Criminal Justice or a related field (bonus)
- Experience with HIPAA, data privacy, and/or data security processes (bonus)
- Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar (bonus)
- Certified Professional Coder (CPC) or similar (bonus)
Responsibilities
- Identify and conduct investigations into suspected FWA with high autonomy
- Document findings to include formal investigative reports, tables, graphs, audit logs, and other supporting documentation
- Met metrics to align with caseload, turn around times, and other unit-wide goals
- Continue to monitor providers with substantiated findings to track behavior change
- Participate in the development and presentation of FWA-related education for Oscar teams
- Build evidentiary files for potential recovery, legal action, and/or referrals to appropriate outside agencies
- Compliance with all applicable laws and regulations
- Other duties as assigned
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