Fraud Investigator Job at Peraton, United States

SEZDb2h2UjFhTUQxVmpDZk5mUnlabk56
  • Peraton
  • United States

Job Description

Responsibilities

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

What you'll do:

The Fraud Investigator is expected to perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions.  Will work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support.  

  • An investigator uses good judgment and may work independently with minimum supervision and direction.
  • The investigator also may work as part of a team as there may be times when the investigator needs to work with state and/or federal investigators and other personnel. 
  • An investigator handles multiple caseload assignments concurrently; organizes and analyzes complex evidentiary patterns; interviews and obtains statements from witnesses and others.
  • Investigators may also be required to complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated. There may also be times when the investigator will need to apply federal or state laws.
  • Investigators are expected to research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview.
  • Investigators then analyze the results of the investigation to ascertain if the allegations have been corroborated and work with others to determine the appropriate steps that need to be taken to address the issues.
  • As part of an investigation, the investigator will need to prepare correspondence; be objective and accurate and communicate with others with tact.
  • There may be times when investigators need to react to unplanned situations, be flexible in planning their activities and adopt effective courses of action.
  • As investigators will be working with health privacy information, they also must maintain confidentiality and understand all the laws, rules and regulations concerning health privacy.
  • Telework available from the United States

Qualifications

Basic Qualifications:

  • 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD
  • At least 2 years investigative experience preferred
  • Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures
  • Strong investigative skills
  • Strong communication and organization skills
  • Strong PC knowledge and skills
  • US Citizenship is Required

Desired Qualifications:

  • Strong background in investigations.
  • Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
  • Knowledge of investigative practices regarding healthcare providers.
  • Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures
  • Background in evaluating, reviewing and analyzing medical claims and records
  • Ability to learn and operate a variety of data systems, equipment and tools used in investigations

Essential Functions:

  • This position may require the incumbent to appear in court to testify about work findings.
  • Ability to perform research and draw conclusions
  • Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
  • Ability to organize a case file, accurately and thoroughly document all steps taken
  • Ability to compose correspondence, reports and referral summary letters
  • Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters
  • Ability to communicate effectively, internally and externally
  • Ability to interpret laws and regulations
  • Ability to handle confidential material.
  • Ability to report work activity on a timely basis.
  • Ability to work independently and as a member of a team to deliver high quality work
  • Ability to attend meetings, training, and conferences, overnight travel required .

Peraton Overview

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can’t be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we’re keeping people around the world safe and secure.

Target Salary Range

$51,000 - $82,000. This represents the typical salary range for this position based on experience and other factors.

Job Tags

For contractors, Remote job, Flexible hours, Night shift,

Similar Jobs

Innovative Appliance Repair of Woodland Hills

Remote Retail Associate $40/H Job at Innovative Appliance Repair of Woodland Hills

We are looking for a motivated and customer-oriented Remote Retail Associate to join our team. This is a work-from-home position that offers the flexibility to assist customers and manage retail inquiries from the comfort of your home. As a Remote Retail Associate, you... 

Copilot Careers

Substitute Teacher - No Experience Required, With a Degree! Job at Copilot Careers

 ...encourage you to apply for the role of Substitute Teacher in our district. Qualifications: Bachelor's Degree or Higher Proficient in English (speaking, reading, writing) Responsibilities: Provide meaningful instruction to students in assigned... 

Amergis Healthcare Staffing

Certified Teacher's Assistant Job at Amergis Healthcare Staffing

 .... We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the... 

Ford Motor Company

Program Manager, Model e Programs Job at Ford Motor Company

 ...ourselves. Are you ready to change the way the world moves? Fords Model E team is charged with delivering the companys vision of a...  ...enterprise of Ford. You will be in the prime position to build your own brand, experience progressive career development while engaging with C... 

National Concessions Management, LLC

Airport Lounge Ambassador Job at National Concessions Management, LLC

 ...Job Description Job Description Do you have what it takes to work in one of the busiest airport lounges in Atlanta? If so, we're looking for YOU ! Do you have experience working in a restaurant, country club, night club, hotel or have an interest working in hospitality...