New York, New York, United States · Hybrid
$68k–$99k/yr
Hi, we're Oscar. We're hiring a Senior Analyst, Special Investigations Unit Clinical Investigator to join our SIU. Oscar is the first health insurance company built around a full stack technology platform and a relentles…
Skills: Clinical auditing, Medical record review, Utilization management, Clinical documentation improvement, Forensic auditing
Texas, United States · Remote OK
Hi, we're Oscar. We're hiring a Bilingual Customer Service Representative to join our Member and Provider Services team. Oscar is the first health insurance company built around a full stack technology platform and a rel…
Skills: Bilingual Spanish, Customer Service, Healthcare Administration, Case Management, Data Entry
Georgia, United States · Remote OK
Hi, we're Oscar. We're hiring a Bilingual Customer Service Representative to join our Member and Provider Services team. Oscar is the first health insurance company built around a full stack technology platform and a rel…
Skills: Bilingual Spanish, Customer Service, Healthcare Experience, Case Management, Data Entry
Florida, United States · Remote OK
Hi, we're Oscar. We're hiring a Bilingual Customer Service Representative to join our Member and Provider Services team. Oscar is the first health insurance company built around a full stack technology platform and a rel…
Skills: Bilingual Spanish, Customer Service, Healthcare Administration, Case Management, Data Entry
Arizona, United States · Remote OK
Hi, we're Oscar. We're hiring a Bilingual Customer Service Representative to join our Member and Provider Services team. Oscar is the first health insurance company built around a full stack technology platform and a rel…
Skills: Bilingual Spanish, Customer Service, Healthcare Experience, Case Management, Data Entry
Atlanta, Georgia, United States · Remote OK
$179k–$235k/yr
Hi, we're Oscar. We're hiring a Senior Director to join our Network Contracting. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We…
Skills: Network contracting, Provider network strategy, Contract negotiation, Healthcare delivery systems, Reimbursement models
Tempe, Arizona, United States · Hybrid
$179k–$235k/yr
Hi, we're Oscar. We're hiring a Senior Director to join our Network Contracting. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We…
Skills: Network contracting, Provider network strategy, Contract negotiation, Healthcare delivery systems, Reimbursement models
Dallas, Texas, United States · Remote OK
$179k–$235k/yr
Hi, we're Oscar. We're hiring a Senior Director to join our Network Contracting. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We…
Skills: Network contracting, Provider network strategy, Contract negotiation, Healthcare provider relations, Cost containment
New York, New York, United States · Hybrid
$199k–$261k/yr
Hi, we're Oscar. We're hiring a Senior Director to join our Network Contracting. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We…
Skills: Network contracting, Provider network strategy, Contract negotiation, Healthcare provider relations, Cost containment
New York, New York, United States · Hybrid
$164k–$215k/yr
Hi, we're Oscar. We're hiring a Senior Software Engineer, Fullstack to join our Engineering team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our membe…
Skills: Fullstack development, Typescript, Javascript, Python, Golang
New York, New York, United States · Hybrid
$136k–$178k/yr
Hi, we're Oscar. We're hiring a Manager, Investor Relations to join our Investor Relations. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our …
Skills: Investor relations, Financial modeling, Valuation, Sell-side equity research, Market intelligence
New York, New York, United States · Hybrid
$136k–$178k/yr
Hi, we're Oscar. We're hiring a Senior Manager, People Compliance to join our People team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our m…
Skills: HR Compliance, Visa & Immigration Management, Health & Safety, Employee Policy Design, Talent Risk Analysis
New York, New York, United States · Remote OK
$26/hr–$39/hr
Hi, we're Oscar. We're hiring a Senior Analyst, Regulatory Licensing to join our Corporate Counsel team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on…
Skills: Regulatory licensing, Project management, Compliance, Risk adjustment, Health insurance
Minnesota, United States · Remote OK
$134k–$177k/yr
Hi, we're Oscar. We're hiring an Associate Director, National Partnerships ICHRA Growth to join our Sales Team. Oscar is the first health insurance company built around a full stack technology platform and a relentless f…
Skills: Business development, Sales, Strategic growth, Market expansion, Relationship management
Dallas, Texas, United States · Remote OK
$92k–$120k/yr
Hi, we're Oscar. We're hiring an Operational Forecasting Associate to join our Workforce Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus o…
Skills: Operational forecasting, Data analysis, SQL, R, Python
Atlanta, Georgia, United States · Remote OK
$92k–$120k/yr
Hi, we're Oscar. We're hiring an Operational Forecasting Associate to join our Workforce Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus o…
Skills: Operational forecasting, Data analysis, SQL, R, Python
Tempe, Arizona, United States · Hybrid
$92k–$120k/yr
Hi, we're Oscar. We're hiring an Operational Forecasting Associate to join our Workforce Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus o…
Skills: Operational forecasting, Workforce management, Data analysis, SQL, R
New York, New York, United States · Hybrid
$102k–$134k/yr
Hi, we're Oscar. We're hiring an Operational Forecasting Associate to join our Workforce Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus o…
Skills: Operational forecasting, Data analysis, SQL, Financial planning, Workforce management
Hybrid
$102k–$134k/yr
Hi, we're Oscar. We're hiring a Program Lead, Payor Connections/Interoperability to join our Risk Adjustment team. Oscar is the first health insurance company built around a full stack technology platform and a relentles…
Skills: Interoperability, Provider Outreach, Project Planning, Operational Strategy, Data Validation
New York, New York, United States · Remote Solely
$116k–$153k/yr
Hi, we're Oscar Medical Group. We're hiring a Bilingual Nurse Practitioner or Physician Assistant to join our Virtual Primary Care team. At Oscar Medical Group, we are refactoring healthcare. We want to help each of our …
Skills: Telemedicine, Patient care, Primary care, Urgent care, Spanish fluency
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The Clinical Investigator detects and audits aberrant billing patterns within claims and clinical documentation to ensure compliance with regulations and clinical guidelines. They also facilitate professional discussions with providers to correct billing behaviors and build evidentiary files for potential recovery or legal action.
Candidates must hold an active, unrestricted Registered Nurse (RN) license with at least 3 years of direct patient care experience. Additionally, they require 2+ years of experience in medical review, utilization management, or clinical documentation improvement with expertise in forensic clinical guidelines.
Hi, we're Oscar. We're hiring a Senior Analyst, Special Investigations Unit Clinical Investigator to join our SIU.
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.
The Senior Analyst, SIU Clinical Investigator detects and audits aberrant billing patterns within claims and clinical documentation, using forensic clinical expertise to protect the integrity of healthcare spend. You will perform comprehensive pre-payment and post-payment reviews of medical records to ensure billed services align with established clinical guidelines, CMS regulations, and contractual obligations. Beyond individual claim accuracy, you will analyze provider behavior to identify schemes such as record cloning, upcoding, and unbundling that may be invisible to automated systems. As a clinical subject matter expert, you will act to translate audit findings into relevant education. You will facilitate professional discussions with colleagues and providers to correct billing behaviors and promote long-term compliance. You will partner with clinical and non-clinical investigators to build evidentiary files for potential recovery, legal action, or referrals to appropriate outside agencies.
You will report into the Investigations Manager, SIU.
Work Location: This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Virginia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area.
If you live within commutable distance to our New York City office (in Hudson Square) or our Tempe office (off the 101 at University Ave), you will be expected to come into the office at least three days each week. Otherwise, this is a remote / work-from-home role. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule.
The base pay for this role in the states of New Jersey and New York is: $75,348 - $98,894 per year. The base pay for this role in all other locations is: $67,813 - $89,004 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
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.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
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 ([email protected]) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.
We're on a mission to reinvent health insurance.
Oscar Health is a leading healthcare technology company, whose mission is to make a healthier life accessible and affordable for all.
Offices: New York, New York 10013, US · Playa Vista, CA 90066, US · Tempe, AZ 85281, US
We're on a mission to reinvent health insurance.
Oscar Health is a leading healthcare technology company, whose mission is to make a healthier life accessible and affordable for all.
Offices: New York, New York 10013, US · Playa Vista, CA 90066, US · Tempe, AZ 85281, US
