Fraud Referral Specialist – Medicare

Peraton; Florida; Remote; USD 55,000 - 75,000; Full time

Job summary

SafeGuard Services (SGS), a Peraton subsidiary, is seeking a Fraud Referral Specialist to evaluate referrals, conduct investigations, and identify potential fraud within Medicare programs. The role involves responding to data requests, analyzing claims data for anomalies, conducting interviews, and reporting findings with a focus on swift follow-up actions.

Telework is available from Florida, and the candidate should be prepared to coordinate with field investigators and data teams as needed.

Qualifications

• U.S. citizenship is required.
• Strong interpersonal, analytical, research, and organizational skills are required.
• Excellent verbal and written communications.
• Strong PC knowledge and skills; proficiency with Excel for data sorting/filtering.
• Strong time management and organizational skills required.
• Self-driven and motivated.

Responsibilities

• Perform research and draw conclusions.
• Present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government.
• Organize a case file, accurately and thoroughly document all steps taken.
• Conduct background investigation on providers within the Medicare program.
• Compose correspondence, reports, and referral summary letters.
• Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters.
• Telework available from Florida.

Skills

Interpersonal skills

Analytical

Research

Organizational skills

Communication

PC knowledge

Time management

Self-driven

U.S. citizenship

Education

High School Diploma

Bachelor’s degree

Tools

Excel

Job description

Basic Qualifications:

• 0 years with BS/BA; 4 years with a HS Degree
• Strong interpersonal, analytical, research, and organizational skills are required
• Excellent verbal and written communications
• Strong PC knowledge and skills
• Strong use of Excel and being able to sort and filter data
• Strong time management and organizational skills required
• Self-driven and motivated
• U.S. citizenship required

Desirable Qualifications:

The most competitive candidates will have:

• 1 or 2 years of investigative or analytical experience preferred
• This position may require the incumbent to appear in court to testify about work findings.
• 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, some overnight travel 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 Referral Specialist to our SGS team of talented professionals.

What you'll do:

The position requires the individual to use a variety of tools to assist in the evaluation of referrals and complaints, as well as development of investigations to identify potential fraud. Development of investigations commonly include responding to referrals from other entities, fielding requests for data and support, analyzing and interpreting claims data for aberrancies, conducting interviews, and reporting findings with a focus on taking quick and appropriate follow up actions. Follow up actions commonly include referrals to field investigative teams or to the data team for further analysis.

• Perform research and draw conclusions
• Present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
• Organize a case file, accurately and thoroughly document all steps taken
• Conduct background investigation on providers within the Medicare program
• Compose correspondence, reports, and referral summary letters
• Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters
• Telework available from Florida