高级分析师 - SIU 调查员
Senior Analyst, SIU Investigator
你好，我们是Oscar。我们正在招聘一名高级分析师，SIU调查员加入我们的SIU团队。
Oscar是首家围绕完整技术平台建立的健康保险公司，并始终专注于为会员提供优质服务。我们于2012年创立Oscar，旨在打造我们自己希望拥有的健康保险公司——一家像家庭医生一样的公司。
关于该职位：
高级分析师，SIU调查员负责检测、调查并推动在理赔和注册数据中观察到的异常行为的改变。你将分析数据并管理调查案件，从识别到解决，包括追回超额支付、衡量行为变化，并完成必要的报告以通过调查和内部流程改进实现欺诈、浪费和滥用（FWA）追偿和节省目标。
你将向SIU调查经理汇报工作。
工作地点：
这是一个远程职位，面向居住在以下地区的候选人：亚利桑那州；佛罗里达州；佐治亚州；或德克萨斯州。虽然你的日常工作将在家中完成，但可能需要偶尔出差参加团队会议和公司活动。#LI-Remote
薪资透明：该职位的基本薪资为：每年72,036至94,547美元。你还有资格享受员工福利，参与Oscar的无限休假计划和年度绩效奖金。
你必须目前有资格在美国全职工作。Oscar不会为该职位的申请人提供工作签证。
职责：
- 独立识别并开展已知或疑似FWA的调查
- 编写文件以支持调查结果，包括正式报告、图表、审计日志和其他支持性文件
- 通过调查和内部流程改进达成目标——至少初期应实现同比增加——以实现FWA追偿和节省
- 对以往案件进行分析，以指导未来类似理赔或案件的识别及相关节省（即，帮助从“先支付后追讨”转向预防性编辑和预支付活动）
- 参与FWA相关教育内容的开发和展示，面向Oscar团队
- 遵守所有适用的法律法规
- 其他指派的任务
要求：
- 3年以上保险理赔调查经验，或在执法机构的专业调查经验
- 1年以上使用Python、React、Kubernetes、Stripe等工具的经验
查看英文原文
Hi, we're Oscar. We're hiring a Senior Analyst, SIU Investigator to join our SIU team.
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the role:
The Senior Analyst, Special Investigations Unit Investigator detects, investigates, and produces change in aberrant behavior observed in claims and enrollment data. You will analyze data and manage investigative caseload from identification through to resolution including overpayment recovery, measuring behavior change and completing necessary reporting to meet monetary and caseload targets through investigations and internal process improvements for Fraud Waste and Abuse (FWA) recoupments and savings.
You will report into the Investigations Manager, SIU.
Work Location:
This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote
Pay Transparency: The base pay for this role is: $72,036 - $94,547 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
You must be currently authorized to work in the United States on a full-time basis. Oscar will not sponsor applicants for this role.
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– which should, at least initially, increase year-over-year – for FWA recoupments and savings
- Perform analysis on prior cases to inform future identification of similar claims or cases and associated savings (i.e., help move from “pay-and-chase” to preventive edits and prepayment activity)
- 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 points:
- Bachelor's degree in Criminal Justice or a related field
- Experience working in health insurance across several product lines specifically with claims processing, billing, reimbursement, or provider contracting.
- Experience with HIPAA, data privacy, and/or data security processes
- Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar
- Certified Professional Coder (CPC) or similar
This is an authentic Oscar Health job opportunity.
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.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
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.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.