Investigations Manager

Oscar Logo

Oscar

πŸ’΅ $88k-$129k
πŸ“Remote - Worldwide

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
  • Oscar’s unlimited vacation program

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