Oscar Health

Director, Special Investigations Unit - Remote

2 weeks agoRemote

Hi, we're Oscar. We’re hiring a Director to lead the Special Investigations Unit (SIU) within our Compliance team. 

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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:

Oscar’s SIU reviews and resolves reports of potential fraud, waste, and abuse (FWA), while working to implement safeguards that prevent future FWA before it happens.  We use data analysis, coding review, investigative techniques, and grit to make a meaningful impact on Oscar’s bottom line – and by extension to keep health care costs down.

As the Director of the SIU, you will refine the existing team structure and processes, considering how they can and should scale with Oscar’s expansion.  You will design and lead cross-functional initiatives, building Oscar’s medical and pharmacy anti-FWA efforts in collaboration with the Data, Insurance Operations, Legal, Clinical, and Tech teams.  You will not only leverage your own experience and industry-standard practices to help Oscar benchmark its FWA activities, but also demonstrate innovation and creativity in exceeding these benchmarks.

You will report into the New York-based Vice President of Compliance.  If you live within a commutable distance of one of Oscar’s offices, you may take this position as a hybrid role, working part of the time in one of Oscar’s offices and part of the time remotely.  Alternatively, you may work remotely in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington (note that this list of states is subject to change).

Responsibilities:

  • Lead Oscar’s cross-functional anti-FWA efforts, with dedicated responsibility for the SIU
  • Set and meet justifiable and appropriately scaling goals for anti-FWA activity across Oscar
  • Design and implement measurable, repeatable, and scalable tools and processes for the SIU, always identifying opportunities for efficiency and automation
  • Stay abreast of industry developments, new schemes, and technological and regulatory developments, in order to implement targeted and responsive anti-fraud efforts
  • Foster widespread engagement – by internal and external stakeholders – with Oscar’s FWA program
  • Ensure that Oscar meets its legal and regulatory obligations related to FWA
  • Make referrals to, generate required deliverables for, and where appropriate maintain relationships with, regulatory and law enforcement officials
  • Support and chart growth paths for your team members, and provide day-to-day leadership and guidance in their areas of responsibility

Requirements:

  • (Legal requirement) A bachelor’s degree in Criminal Justice or a related field, OR five years of insurance claims investigation experience and/or professional investigation experience with law enforcement agencies, OR seven years of professional investigation experience involving economic or insurance-related matters
  • 7+ years’ total work experience in insurance, health care, tech, investigations, and/or law enforcement
  • Knowledge of applicable fraud statutes and regulations, and of CMS guidelines
  • Experience managing internal teams, external delegates and cross-functional initiatives

Bonus points:

  • AHFI, CFE, CAFP, or similar
  • CPC, RHIT, RHIA, or other coding or reimbursement experience
  • Experience with HIPAA, data privacy, and/or data security processes
  • Experience working with regulators governing (public or private) health insurance carriers

Life at Oscar: 

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.

We aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: 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 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.

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 pay. Read the full policy here.

Life at Oscar: 

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.

We aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: 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 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.

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 pay. Read 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, employees conducting sales work in the field and employees conducting at-home or in-person visits with members.

Job ID: 2173075