Fraud Investigator Associate

Peraton; United States; À distance; USD 55 000 - 75 000; Plein temps

Résumé du poste

SafeGuard Services (SGS), a Peraton subsidiary, seeks an entry-level Fraud Investigator Associate to join the team. Work under direct supervision to perform high-level investigations of medical service providers, developing cases and reports for potential action, including referrals to law enforcement and overpayment recovery.

The role supports investigators across data sources, communicates findings, and develops corrective actions while maintaining confidentiality and privacy protections.

Qualifications

• Investigative and analytical experience required.
• Strong communication and organizational skills.
• US citizenship required.
• Strong PC knowledge and skills.

Responsabilités

• Research and draw conclusions to support investigations.
• Document information to support investigative workload and cite regulatory references.
• Organize case files and thoroughly document steps.
• Compose correspondence, reports, and referral summaries.
• Educate providers and stakeholders on program safeguards.
• Communicate effectively with internal and external teams.
• Maintain confidentiality and report activities timely.
• Attend meetings; travel may be required.

Connaissances

Investigative experience

Analytical skills

Communication

Organization

PC proficiency

US citizenship

Formation

BS/BA

HS diploma or equivalent

Description du poste

Basic Qualifications:

• 0 years’ experience with BS/BA, or 4 years’ experience with a HS diploma/equivalent
• Investigative and analytical experience
• Strong communication and organization skills
• Strong PC knowledge and skills
• US. citizenship required

The most competitive candidates will have:

• Strong background in investigations or compliance audits.
• Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments.
• Knowledge of investigative or audit 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:

• Ability to perform research and draw conclusions
• Ability to document information in support of investigative/audit workload of the team, 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 under direct supervision as a member of a team to deliver high-quality work
• Ability to attend meetings, training conferences and overnight travel may be required.

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 Associate to our SGS team of talented professionals.

What you’ll do:

The position is an entry level fraud investigator/auditor position expected to work under the direct supervision of a team manager and/or team lead. The team performs high level complex investigations of medical professional service providers and develops cases/reports for future action, including referral to law enforcement, education, over payment recovery and other administrative actions. This position will support the team of fraud investigators/auditors and will work with internal resources and external agencies to develop cases/audits and corrective actions as well as respond to requests for data and support.

• The investigator uses good judgment and will work under the direct supervision of team manager and/or team lead
• The investigator will work in support of a team who works with state and/or federal investigators and other personnel.
• The investigator handles multiple caseload assignments concurrently; organizes and analyzes information in support of the team’s workload
• The Investigator may also be required to assist in the completion of complex reports that apply regulations or rules to the program(s) affected by the behavior being reviewed.
• Investigators will work collaboratively within the team and participate in researching and understanding the relevant offenses being reviewed; participate in conducting efficient and effective investigations/audits concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview.
• Investigators will collaborate with team members to analyze the results of the investigation/audit 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/auditor 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 Eastern Time Zone