[Remote] SIU Coding Auditor
Note: The job is a remote job and is open to candidates in USA. Oscar is a health insurance company built around a full stack technology platform focused on serving its members. The Associate, SIU Coding Auditor will execute anti-fraud initiatives, support operational and financial targets, and ensure team productivity while maintaining high quality standards.
Responsibilities
• Perform quality checks of other team members' coding audit reviews and deliver in written or verbal form to ensure accuracy and compliance with coding standards and Oscar policy
• Review dashboards and interpret performance data in support of production goals; Recommend response and inform management before deadlines are missed
• Identify and help develop new processes to ensure efficient and effective audit functions
• Perform complex reviews of medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar
• Explicitly document findings including sources used to support decision making and in a way that can be easily understood by non clinicians or coders
• Participate in educational calls or written communications to articulate findings to providers under SIU review
• Facilitate team and cross-team education
• Compliance with all applicable laws and regulations
• Other duties as assigned
Skills
• Bachelor's degree or equivalent years of experience
• Certified Professional Coder (CPC) designation or similar
• 3+ years of coding or auditing experience across multiple specialties
• Certified Professional Medical Auditor
• Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), other coding certifications or similar
• Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
• Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting
• Experience with HIPAA, data privacy, and/or data security processes
• Experience working with regulators governing (public or private) health insurance carriers
Benefits
• Employee benefits
• Participation in Oscar's unlimited vacation program
• Annual performance bonuses
• 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
Company Overview
• Oscar is a health insurance company that offers individual and family plans, medicare advantages, and small group products. It was founded in 2012, and is headquartered in New York, New York, USA, with a workforce of 1001-5000 employees. Its website is http://www.hioscar.com.
Company H1B Sponsorship
• Oscar Health has a track record of offering H1B sponsorships, with 19 in 2025, 24 in 2024, 22 in 2023, 36 in 2022, 13 in 2021. Please note that this does not guarantee sponsorship for this specific role.
Apply Now
Apply Now
Responsibilities
• Perform quality checks of other team members' coding audit reviews and deliver in written or verbal form to ensure accuracy and compliance with coding standards and Oscar policy
• Review dashboards and interpret performance data in support of production goals; Recommend response and inform management before deadlines are missed
• Identify and help develop new processes to ensure efficient and effective audit functions
• Perform complex reviews of medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar
• Explicitly document findings including sources used to support decision making and in a way that can be easily understood by non clinicians or coders
• Participate in educational calls or written communications to articulate findings to providers under SIU review
• Facilitate team and cross-team education
• Compliance with all applicable laws and regulations
• Other duties as assigned
Skills
• Bachelor's degree or equivalent years of experience
• Certified Professional Coder (CPC) designation or similar
• 3+ years of coding or auditing experience across multiple specialties
• Certified Professional Medical Auditor
• Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), other coding certifications or similar
• Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
• Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting
• Experience with HIPAA, data privacy, and/or data security processes
• Experience working with regulators governing (public or private) health insurance carriers
Benefits
• Employee benefits
• Participation in Oscar's unlimited vacation program
• Annual performance bonuses
• 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
Company Overview
• Oscar is a health insurance company that offers individual and family plans, medicare advantages, and small group products. It was founded in 2012, and is headquartered in New York, New York, USA, with a workforce of 1001-5000 employees. Its website is http://www.hioscar.com.
Company H1B Sponsorship
• Oscar Health has a track record of offering H1B sponsorships, with 19 in 2025, 24 in 2024, 22 in 2023, 36 in 2022, 13 in 2021. Please note that this does not guarantee sponsorship for this specific role.
Apply Now
Apply Now