πUnited States
Investigations Manager
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Oscar
π΅ $88k-$129k
πRemote - Worldwide
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Summary
Join Oscar's Special Investigations Unit (SIU) as an Investigations Manager and lead a team in executing anti-fraud programs. You will develop investigative strategies, manage team goals, create policies and procedures, and foster engagement with partners. This role requires a Bachelor's degree in Criminal Justice or equivalent experience, relevant certifications, and experience with fraud statutes and regulations. The position offers a blended work culture with remote options, competitive pay, and comprehensive benefits. The base pay varies by location and experience. Oscar is committed to diversity and inclusion.
Requirements
- 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
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
Preferred Qualifications
- 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
Benefits
- 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
- Annual performance bonuses
- Oscarβs unlimited vacation program
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