What are the responsibilities and job description for the Healthcare SIU Investigator position at Oscar Insurance?
A company is looking for a SIU Investigator (Healthcare) to join their team.Key ResponsibilitiesIdentify and conduct investigations into known or suspected fraud, waste, and abuse (FWA)Develop documentation to substantiate findings, including reports and audit logsMeet targets for FWA recoupments and savings through investigations and process improvementsRequired Qualifications3 years of insurance claims investigation experience or professional investigation experience with law enforcement1 year experience with fraud statutes and regulations, and federal guidelines on recoupmentsBachelor's degree in Criminal Justice or a related field (preferred)Experience working in health insurance, specifically with claims processing or provider contracting (preferred)Relevant certifications such as Certified Fraud Examiner (CFE) or Certified Professional Coder (CPC) (preferred)
