Fraud Investigator Associate

🔥 12 hours ago

🦌 Connecticut, Maine, +8 more states – Remote

🦌 Connecticut – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🍁 Vermont – Remote

💵 $39k - $62k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Peraton

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

Peraton is a mission-focused enterprise that supports national security initiatives through advanced IT and cyber services. They provide capabilities in areas such as cyber defense, cloud operations, engineering, and intelligence. With a commitment to solving complex challenges, Peraton integrates data-driven technologies to ensure mission success for their military and government clients.

📋 Description

• Perform entry-level fraud investigation and audit work under direct supervision of a team manager or team lead • Support complex investigations of medical professional service providers • Develop cases and reports for law-enforcement referral, education, overpayment recovery and other administrative actions • Work with internal resources, external agencies, state and federal investigators, and other personnel • Handle multiple caseload assignments concurrently • Organize and analyze information supporting team investigations and audits • Assist with complex reports applying program regulations and rules • Research relevant offenses and conduct efficient investigations and audits • Detect or verify suspected violations through observation, record examination and interviews • Analyze investigation and audit results to determine whether allegations are corroborated • Help determine appropriate corrective actions • Prepare objective, accurate correspondence and communicate tactfully • Maintain confidentiality of health privacy information and comply with applicable laws, rules and regulations

🎯 Requirements

• 0 years’ experience with BS/BA, or 4 years’ experience with a HS diploma/equivalent • Investigative and analytical experience • Strong communication and organization skills • Strong PC knowledge and skills • US citizenship required • Strong background in investigations or compliance audits preferred for competitive candidates • Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments • Knowledge of investigative or audit practices regarding healthcare providers • Knowledge of Medicare and/or Medicaid programs and related rules, regulations, policies and procedures • Background evaluating, reviewing and analyzing medical claims and records • Ability to learn and operate data systems, equipment and tools used in investigations • Ability to perform research and draw conclusions • Ability to document investigative/audit information and identify regulatory violations or alleged fraud schemes • Ability to organize case files and accurately document all steps taken • Ability to compose correspondence, reports and referral summary letters • Ability to educate providers, provider associations, law enforcement, contractors and beneficiary advocacy groups • Ability to communicate effectively internally and externally • Ability to interpret laws and regulations • Ability to handle confidential material • Ability to report work activity in a timely manner • Ability to work under direct supervision as part of a team • Ability to attend meetings and training conferences; overnight travel may be required

🏖️ Benefits

• Telework available from the NE UPIC jurisdiction • Overtime eligibility may apply • Shift differential may apply • Discretionary bonus may be available • Attendance at training conferences • Overnight travel opportunities/requirements