External Job Posting Title Fraud Investigative Coordinator

Peraton; Pennsylvania; Remote; USD 51,000 - 82,000; Full time

Job summary

Peraton is seeking a Fraud Investigator Coordinator for SafeGuard Services (SGS) to join the Insurance/Healthcare investigations team. You will conduct fraud investigations, interview subjects, and refer cases to law enforcement as needed, providing subject matter expertise.

The role is primarily telework from a location near Camp Hill, PA, with occasional on-site work. Strong organizational skills and familiarity with claims processes are essential for success.

Qualifications

• Proven strong organizational skills.
• Experience with investigations and data systems.
• US citizenship required.
• Proficient with Microsoft Office Suite and standard investigative tools.

Responsibilities

• Investigates and resolves potential fraud or abuse in the Insurance/Healthcare space.
• Interviews subjects as part of investigations.
• Collaborates with law enforcement by referring cases and providing SME.
• Prepares appeals documents within specified deadlines.
• Researches and reports appeals activity to support investigations.
• Telework with occasional on-site Camp Hill, PA presence.

Skills

Strong organizational skills

Independent & team collaboration

Effective communication

Education

BS 2-4 years, MS 0-2 or HS 8-10

Tools

Microsoft Office Suite

Adobe

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.

We are looking to add a Fraud Investigator Coordinator to our SGS team of talented professionals.

What you'll do:

This position investigates and takes actions to resolve and/or prevent potential fraud or abuse in the Insurance/Healthcare space.Performs investigations to identify and resolve fraud or abuse. Interviews subjects as part of investigations. Collaborate with law enforcement by referring cases and providing subject matter expertise. Knowledge of claims/reimbursement practices and regulations. Understanding of regulatory environment. Knowledge of investigations processes, tools and practices. Case development and prosecution procedures. Additional activities may include:

• Receive requests from other entities and prepare appeals documents within specific time parameters
• Research and reporting appeals activity to support investigations
• Ability to perform appeals research using various systems
• Support with other clerical activities as needed
• The position is primarily telework, with the employee located near Camp Hill, PA.
• On-site presence in Camp Hill, PA office may be required occasionally.

Qualifications

Basic Qualifications:

• BS 2-4 Years, MS 0-2 or HS 8-10
• Proven strong organizational skills
• Utilizea personal computer.
• Proficient in Microsoft Office Suite.
• Proficient with Adobe
• Able to lift up to 50 lbs.
• US. citizenship required

The most competitive candidates will have:

• Ability to search different systems to determine re-reviews of entities
• Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures
• Knowledge of Medicare Appeals process and different levels of Appeals
• Ability to learn and operate a variety of data systems, equipment and tools used in investigations

Essential Functions:

• Ability to perform research and draw conclusions
• Ability to organize a case file, accurately and thoroughly document all steps taken
• Ability to compose correspondence, reports and referral summary letters
• 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, may require overnight travel.

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. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

EEO

EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.