Audit Coordinator managing internal audit plans and compliance at YDUQS. Supporting the execution of strategic educational projects and risk management initiatives.
About the role
- Senior Analyst conducting fraud investigations for Oscar Health, focusing on healthcare claims and member enrollment data. Managing investigations with autonomy and meeting caseload metrics.
Responsibilities
- Identify and conduct investigations into suspected FWA with high autonomy
- Document findings to include formal investigative reports, tables, graphs, audit logs, and other supporting documentation
- Met metrics to align with caseload, turn around times, and other unit-wide goals
- Continue to monitor providers with substantiated findings to track behavior change
- Participate in the development and presentation of FWA-related education for Oscar teams
- Build evidentiary files for potential recovery, legal action, and/or referrals to appropriate outside agencies
- Compliance with all applicable laws and regulations
- Other duties as assigned
Requirements
- 3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies
- 3+ year experience with applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
Benefits
- Employee benefits
- Participation in Oscar's unlimited vacation program
- Annual performance bonuses
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