Investigations Manager, SIU

Hi, we're Oscar. We're hiring a Investigations Manager, SIU to join our SIU team.

Oscar is the first health insurance company built around a full stack technology platform and a 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 Manager, Special Investigations Unit Investigator executes on Oscar’s anti-fraud programs by meeting operational and financial targets while observing legal and regulatory obligations. By leading a team who independently manage caseloads, you will set and work on investigative strategy while supporting and charting growth paths for direct reports’ personal development. The Investigations Manager fosters engagement across all partners, and creates policies, procedures and educational documentation to support an excellent Fraud Waste and Abuse (FWA) program.

You will report to the Associate Director, SIU.

Work Location: 

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. 

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.  

You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $98,400 - $129,150 per year. The base pay for this role in all other locations is: $88,560 - $116,235 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

• Develop and build investigative strategy while creating development paths for teammates
• Manage Investigative Team in meeting their personal and team goals
• Manage team and individual targets through investigations and internal process improvements that support savings goals
• Develop policies, procedures and educational documentation and ensure delivery and compliance.
• Foster engagement across all partners being primary contact and business owner for Investigations team 
• Participate in the development and presentation of FWA-related education for Oscar teams and external partners
• Manage direct and delegated FWA functions and shift priorities to align with operational needs. 
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• Bachelor's degree in Criminal Justice or at least 5 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies
• At least one of the following: 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
• 4+ years of experience with applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity

Bonus Points

• Experience working in health insurance across several products specifically with claims processing, billing, reimbursement, or provider contracting.
• Experience providing group and/or or individual training 
• Experience with HIPAA, data privacy, and/or data security processes
• Experience managing direct reports

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 

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.

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 Notice to Job Applicants.