Fraud Investigator/Auditor

Job not on LinkedIn

🔥 13 minutes ago

🦌 Connecticut, Maine, +9 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 ⚔️ Virginia – Remote

💵 $66k - $106k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 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

• Manage the full case lifecycle of potential fraud, waste, and abuse matters under Medicaid program integrity • Receive, triage, and assess complaints, referrals, and leads • Determine jurisdiction, scope, and preliminary validity of allegations • Analyze provider data, billing patterns, and case documentation • Vet matters for duplicate, prior, or out-of-scope reviews • Coordinate deconfliction with CMS, state Medicaid agencies, managed care organizations, and partner agencies • Document vetting outcomes, case status, contacts, and disposition rationale • Conduct provider audits and investigations, including claims analysis, medical record reviews, and interviews • Identify billing irregularities, documentation gaps, and systemic vulnerabilities • Develop evidence-supported findings for potential administrative, civil, or criminal action • Draft, recommend, and process administrative remedies, including overpayment determinations and referrals • Prepare reports for CMS, state agencies, and law enforcement partners • Support rebuttals, appeals, and settlements related to administrative findings • Maintain comprehensive case documentation in designated tracking systems • Ensure compliance with the CMS Program Integrity Manual, Statement of Work, and state-specific regulations • Contribute to reports, dashboards, and metrics tracking case outcomes, recoveries, and contract performance • Organize and analyze complex evidentiary patterns, interview witnesses, and obtain statements • Research applicable offenses, laws, rules, and regulations • Prepare objective correspondence and investigative reports • Maintain confidentiality of health privacy information

🎯 Requirements

• 5 years of experience with a BS/BA or 3 years with a Masters Degree • Strong investigative skills • Strong communication and organization skills • Strong PC knowledge and skills • Must be a US Citizen • Experience 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 related rules, regulations, policies, and procedures • Background evaluating, reviewing, and analyzing medical claims and records • Ability to learn and operate a variety of data systems, equipment, and investigative tools • Ability to perform research and draw conclusions • Ability to present regulatory violations and alleged schemes or scams to defraud the Government • Ability to organize case files and accurately document investigative steps • Ability to compose correspondence, reports, and referral summary letters • Ability to communicate effectively internally and externally • Ability to interpret laws and regulations • Ability to handle confidential material • Ability to report work activity timely • Ability to work independently and as part of a team • Ability to attend meetings, training, and conferences • Ability to appear in court and testify about work findings

🏖️ Benefits

• Potential eligibility for overtime • Shift differential may be available • Discretionary bonus may be available • Overnight travel required