Fraud Referral Specialist - Medicare

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

Benefits offered by this job

Medical

Dental

Vision

Life Insurance

Health Savings Account

Disability Insurance

Employee Assistance Program

Parental Leave

401(k)

PTO

Company Holidays

Job summary

Peraton is seeking a Fraud Referral Specialist for SafeGuard Services (SGS). The role involves using diverse tools to evaluate referrals and develop investigations to identify potential fraud within Medicare and Medicaid programs.

Telework is available from EST, CST, MST time zones, with duties spanning referrals, data requests, interviews, and reporting findings. You will handle case files, document steps, and coordinate with field teams or data teams for follow-up actions.

Qualifications

• 2 years with a Bachelor’s or 6 years with a HS diploma/equivalent
• At least 2 years of prior experience evaluating complaints or referrals
• Investigative or analytical experience
• Strong interpersonal, analytical, research, and organizational skills are required
• Excellent verbal and written communications

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

Verbal and written communication

Excel data analysis

Time management

US citizenship

Education

Bachelor's degree or equivalent

High School diploma or equivalent

Job description

About Peraton

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 solve the most daunting challenges that our customers face. Visit peraton.com to learn how we're keeping people around the world safe and secure.

Program Overview

Performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse in Medicare and Medicaid programs.

About The Role

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 Specialis t 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.

Qualifications

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

Details

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.

Benefits Statement: Peraton offers eligible employees a variety of benefits including medical, dental, vision, life, health savings account, short/long term disability, EAP, parental leave, 401(k), paid time off (PTO) for vacation, and company paid holidays.

• medical
• dental
• vision
• life
• health savings account
• short/long term disability
• EAP
• parental leave
• 401(k)
• paid time off (PTO) for vacation
• company paid holidays

A full listing of available benefits can be viewed at https://www.careers.peraton.com/benefits.

EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.