Fraud Investigator - Medicare

Peraton; South Carolina; À distance; USD 66 000 - 106 000; Plein temps

Résumé du poste

Peraton's SafeGuard Services (SGS) team seeks a Fraud Investigator to join the Medicare program in a telework-friendly role. You will perform high‑level investigations of medical providers, develop cases for action, and coordinate with law enforcement when needed.

You will analyze claims, review records, interview witnesses, and prepare clear reports. Applicants must be a US citizen and able to work with sensitive health information under applicable laws.

Qualifications

• Investigative experience required.
• Strong communication and organizational skills.
• Proficient PC skills and attention to detail.
• US citizenship required.

Responsabilités

• Conduct high-level investigations of medical providers.
• Develop cases for action including referrals to law enforcement.
• Interview witnesses and obtain statements.
• Prepare complex investigative reports citing regulations.
• Coordinate with internal and external agencies.
• Maintain confidentiality of health information.

Connaissances

Investigative experience

Strong communication skills

Strong organizational skills

PC knowledge

US citizenship

Formation

BS/BA degree

HS diploma

Description du poste

Fraud Investigator - Medicare

Job Locations

US-GA-Home | US-SC-Home

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.

Telework available from Atlanta, GA area or South Carolina

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

What you'll do

The position 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.

Qualifications

Basic Qualifications:

• 5 years with BS/BA; or 9 years with a HS Diploma.
• Investigative experience
• Strong investigative skills
• Strong communication and organization skills
• Strong PC knowledge and skills
• US. citizenship required

Desirable 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 program 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

$66,000 - $106,000. 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.