Fraud Investigative Coordinator

Peraton; United States; Hybrid; USD 51,000 - 82,000; Full time

Job summary

Peraton is seeking a Fraud Investigator Coordinator for SafeGuard Services (SGS) to detect and prevent fraud, waste, and abuse in the Insurance/Healthcare space. The role involves interviewing subjects, developing solid case files, and collaborating with law enforcement as needed.

The position offers primarily telework with on-site Camp Hill, PA occasionally required; strong organizational skills and experience with Medicare/Medicaid are highly valued.

Qualifications

• Proven strong organizational skills.
• Ability to organize a case file, document steps taken, and manage investigations.
• Knowledge of Medicare and/or Medicaid programs and related rules and procedures.

Responsibilities

• Investigate and resolve potential fraud or abuse in the Insurance/Healthcare space.
• Interviews subjects as part of investigations and refers cases to law enforcement when appropriate.
• Develop case files with thorough documentation and case progression notes.
• Perform appeals research and prepare appeals documents within specified time parameters.
• Occasional travel may be required and some duties may be performed remotely.

Skills

Organizational skills

Communication

Independent and team work

Education

BS Degree

MS Degree

HS Diploma

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
• Utilize a 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.