Fraud Investigative Coordinator

Peraton; Pennsylvania; Hybride; USD 51 000 - 82 000; Plein temps

Résumé du poste

Peraton, via its SafeGuard Services (SGS) unit, seeks a Fraud Investigator Coordinator to join a team analyzing and pursuing fraud in the Insurance/Healthcare space. The role involves interviews, case development, and coordination with law enforcement.

The position is primarily telework, located near Camp Hill, PA, with occasional on-site work as needed. Qualified candidates will have relevant education, strong organizational skills, and proficiency with Microsoft Office and Adobe.

Qualifications

• BS with 2–4 years, MS with 0–2 years, or HS with 8–10 years experience.
• Strong organizational skills are required.
• Proficient with Microsoft Office Suite.
• Proficient with Adobe.
• Ability to lift up to 50 lbs.
• US citizenship required.

Responsabilités

• Investigate and resolve potential fraud or abuse in Insurance/Healthcare.
• Interview subjects as part of investigations and refer cases to law enforcement as needed.
• Develop case files and prepare appeals documents within timelines.
• Research and report appeals activity to support investigations.
• Occasional on-site work at Camp Hill, PA; primarily telework.

Connaissances

Organizational skills

Personal computer

Microsoft Office

Adobe

Physical lifting

US citizenship

Formation

Bachelor's degree

MS or HS with equivalent experience

Description du poste

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.