Fraud Investigator Job at Peraton, United States

QU5zdHRnVzQyOEJMc1hTVDhCeTFFVG51
  • Peraton
  • United States

Job Description

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.

What you'll do:

The Fraud Investigator 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.
  • Telework available from the United States

Qualifications

Basic Qualifications:

  • 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD
  • At least 2 years investigative experience preferred
  • Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures
  • Strong investigative skills
  • Strong communication and organization skills
  • Strong PC knowledge and skills
  • US Citizenship is Required

Desired 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 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

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

$51,000 - $82,000. This represents the typical salary range for this position based on experience and other factors.

Job Tags

For contractors, Remote job, Flexible hours, Night shift,

Similar Jobs

Medical College of Wisconsin

Pediatric Adolescent Medicine Job at Medical College of Wisconsin

Childrens Wisconsin Medical College of Wisconsin The Department of Pediatrics at the Medical College of Wisconsin (MCW) and Childrens Wisconsin (CW), seeks a board certified/board eligible physician to join our expanding Pediatric Adolescent Medicine section. ...

Midwestern University

Research Assistant Job at Midwestern University

 ...Summary The Glendale campus of Midwestern University is currently seeking a Research Assistant to work in the Department of Physiology. The selected candidate will provide both administrative and technical support to research faculty by coordinating and performing the... 

Mission Electric Supply Inc.

Delivery Driver Job at Mission Electric Supply Inc.

Daily deliveries to construction sites and our Temecula branch. Pulling orders for deliveries and stocking warehouse shelves. We provide in house Electrical distribution training and are looking for long term employees that want to start out driving and working in our ...

The Workshop LA

Social Media Manager Job at The Workshop LA

 ...Are you passionate about sports, fashion, and the ever-evolving world of social media? Do you have a knack for creating engaging, elevated, and humorous content that resonates with luxury consumers? If so, were looking for you to join our client's team as a Social Media... 

Fayette County Public Schools (KY)

Language Arts Teacher Job at Fayette County Public Schools (KY)

 ...Position: Middle School Language Arts Instructor Location: Mary E. Britton Middle School Fayette Countys newest school, where innovation meets opportunity. Reports To: Principal or designee Type: Certified | Salary-based Why Mary E. Britton...