Fraud Referral Specialist - Medicare

Peraton; Fort Meade (MD); Remote; USD 65,000 - 90,000; Full time

Job summary

Peraton is seeking a Fraud Referral Specialist for SafeGuard Services (SGS) to support analysis and investigation of referrals and complaints related to fraud, waste, and abuse in government programs. The role involves using multiple tools to assess referrals, develop investigations, and report findings to drive timely follow-up actions.

Responsibilities include researching cases, evaluating referrals, documenting steps, and communicating with providers, law enforcement, and other stakeholders.

Qualifications

• Two years with a Bachelor’s or six years with a HS diploma/equivalent
• At least 2 years of prior experience evaluating complaints or referrals required
• Investigative or analytical experience
• 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

Responsibilities

• Perform research and draw conclusions
• Evaluate complaints and referrals for further investigation
• 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 position available from EST, CST, MST time Zones.

Skills

Investigative experience

Analytical skills

Interpersonal skills

Research skills

Organizational skills

Verbal and written communication

Excel skills

Time management

Self-motivated

US citizenship

Education

Bachelor's degree

HS diploma or equivalent

Tools

Excel

Job description

Basic Qualifications:

• 2 years with a Bachelors or 6 years with a HS diploma/equivalent
• At least 2 years of prior experience evaluating complaints or referrals required
• Investigative or analytical experience
• 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:

• 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

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
• Evaluate complaints and referrals for further investigation
• 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 position avaialble from EST, CST, MST time Zones.