Senior Analyst, SIU Investigator

Oscar Health

. Identify and conduct investigations into known or suspected Fraud, Waste, and Abuse with high autonomy .

Posted 10/28/2026full-timeRemote • United StatesSenior💰 $64,832 - $94,547 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in fraud investigation, compliance with applicable laws and regulations, and effective documentation of findings. Proficient in analyzing claims and implementing process improvements to enhance fraud prevention and recoupment strategies.

Highest-signal resume keywords

Fraud Investigation ExperienceKnowledge Of Fraud StatutesExperience With HIPAA ComplianceCertified Fraud Examiner (CFE)Bachelor's Degree In Criminal Justice

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingData AnalysisDocumentation DevelopmentAudit Log CreationProcess Improvement

Soft Skills

AutonomyCommunicationPresentation Skills

Certifications & Qualifications

Certified Fraud Examiner (CFE)Accredited Healthcare Fraud Investigator (AHFI)Certified AML And Fraud Professional (CAFP)Certified Professional Coder (CPC)

Industry Keywords

Fraud Waste And Abuse (FWA)Health InsuranceData PrivacyData SecurityFederal Guidelines

About the role

Key responsibilities & impact

Identify and conduct investigations into known or suspected Fraud, Waste, and Abuse with high autonomy
Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and supporting documentation
Meet targets through investigations and internal process improvements for FWA recoupments and savings
Analyze prior cases to inform future identification of similar claims or cases and associated savings
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
Comply with all applicable laws and regulations
Perform other duties as assigned
Report to the Investigations Manager, SIU

Requirements

What you’ll need

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
Must be currently authorized to work in the United States on a full-time basis
Oscar will not sponsor applicants for this role
Bachelor's degree in Criminal Justice or a related field (bonus point)
Experience working in health insurance across several product lines, specifically with claims processing, billing, reimbursement, or provider contracting (bonus point)
Experience with HIPAA, data privacy, and/or data security processes (bonus point)
Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML and Fraud Professional (CAFP), or similar (bonus point)
Certified Professional Coder (CPC) or similar (bonus point)

Benefits

Comp & perks

Employee benefits
Unlimited vacation program
Annual performance bonuses
Medical, dental, and vision benefits
11 paid holidays
Paid sick time
Paid parental leave
401(k) plan participation
Life and disability insurance
Paid wellness time and reimbursements
Occasional travel for team meetings and company events