Job details
Job type full-time part-time
Full job description
Hi, we`re oscarWe`re hiring a senior fwa diagnostic analyst 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 membersWe 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 siu runs or coordinates activities across oscar to reduce the incidence and impact of fraud, waste, and/or abuse (`fwa`) on all our operations.
Your primary role will be to support oscar in its fight against fraudJoining this dynamic team will expose you to the latest trends and patterns in fwa across the healthcare industry – and provide you with the chance to fight fwa by improving the process and efficiencies of the work performed by the siu teamYour work will not only lead to increased savings and recoupments for oscar as a company, but to more affordable and higher-quality health care for the members we serve.
You will report to the lead investigator, who reports to the director, siu.
This is a remote role, you will work remotely in one of the following states: arizona, california, connecticut, florida, georgia, illinois, maryland, massachusetts, michigan, new jersey, new york, north carolina, ohio, pennsylvania, tennessee, texas, utah, virginia, or washingtonNote, this list of states is subject to change.
Responsibilities:
Independently work through an assigned queue of unresolved internal and external waste opportunities and bring them to resolution.
Research the root cause of the issue and determine the appropriate method of correction.
Initiate adjustments of the claims and initiate recovery efforts including offset (if allowed by contract/state).
Monitor recoveries as appropriate and escalate if necessaryEnsure recoveries are reported as required to enable accurate tracking and reporting
Track trending causes of waste to identify themesEscalate repetitive issues to be corrected or mitigated.
Requirements:
Bachelor`s degree or 2+ years of related work experience in claims and claims resolution
2+ years of professional experience
Bonus points:
Certification applicable to this work such as certified fraud examiner (cfe), accredited healthcare fraud investigator (ahfi), certified aml [anti-money laundering] and fraud professional (cafp), certified professional coder (cpc), other coding or billing certifications or similar
Knowledge of applicable state and federal fraud statutes and regulations, as well as guidelines on recoupments and other anti-fwa activity
Experience working in health insurance specifically with claims processing, billing, reimbursement, provider contracting, or enrollment.
Exposure to claims processing systems
Experience with hipaa, data privacy, and/or data security processes
Life at oscar:
At oscar, being an equal opportunity employer means more than upholding discrimination-free hiring practicesIt means that we cultivate an environment where people can be their most authentic selves and find both belonging and supportWe`re on a mission to change health care - an experience made whole by our unique backgrounds and perspectives.
We encourage our members to care for their whole selves, and we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.
Reasonable accommodation:
Oscar applicants are considered solely based on their qualifications, without regard to applicant`s disability or need for accommodationAny 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.
Pay transparency policy:
Oscar ensures that you won`t be discharged or discriminated against based on whether you`ve inquired about, discussed, or disclosed your payRead the full policy here.
Covid-19 vaccine requirements for in-person work:
To protect the health and safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against covid-19 by their start date.
If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our benefits team at accommodations@hioscar.com to submit an accommodations request.
Note: in-person work includes: employees required to work from our offices (either full-time or part-time), employees conducting sales work in the field and employees conducting at-home or in-person visits with members.
