Remote Fraud Auditor Associate – Entry Level

Peraton; Idaho; Hybrid; USD 39,000 - 62,000; Full time

Benefits offered by this job

Telework from ETZ

Job summary

Peraton, SafeGuard Services (SGS), is seeking a Fraud Auditor Associate to join our SGS team. The role supports investigations and audits of medical providers, with supervision by a team manager and collaboration across investigators and external agencies.

You will analyze data, prepare reports, and help address overpayments, privacy requirements, and regulatory compliance. Telework is available from the Eastern Time Zone, and the position is based in the U.S. Idaho market.

Qualifications

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

Responsibilities

• The auditor uses good judgment and will work under the direct supervision of team manager and/or team lead.
• The audit associate will work in support of a team who works with state and/or federal investigators and other personnel.
• The auditor handles multiple caseload assignments concurrently; organizes and analyzes information in support of the team’s workload.
• The auditor 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.
• Auditor 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.
• Auditor 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 audit, the auditor will need to prepare correspondence; be objective and accurate and communicate with others with tact.
• There may be times when auditors need to react to unplanned situations, be flexible in planning their activities and adopt effective courses of action.
• As auditors 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

Skills

Investigative experience

Analytical skills

Communication

PC skills

US citizenship

Education

BS/BA or HS diploma equivalent

Job description

Peraton, SafeGuard Services (SGS), is seeking a Fraud Auditor Associate to join our SGS team. The role supports investigations and audits of medical providers, with supervision by a team manager and collaboration across investigators and external agencies.

You will analyze data, prepare reports, and help address overpayments, privacy requirements, and regulatory compliance. Telework is available from the Eastern Time Zone, and the position is based in the U.S. Idaho market.