Fraud Investigator – Medicare

🔥 22 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $66k - $106k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🚨 AML and Financial Crime

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.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 high-level, complex investigations of medical professional service providers • Develop cases for referral to law enforcement, education, overpayment recovery, and other administrative actions • Work with internal resources and external agencies to develop cases and corrective actions • Respond to requests for data and support • Handle multiple caseload assignments concurrently • Organize and analyze complex evidentiary patterns • Interview witnesses and other individuals and obtain statements • Complete complex investigative reports applying regulations, rules, and applicable federal or state laws • Research relevant offenses and conduct efficient investigations to detect or verify suspected violations • Obtain information and evidence through observation, record examination, and interviews • Analyze investigation results and determine whether allegations are corroborated • Prepare correspondence and referral summary letters • Conduct provider site verifications, including monthly field work as needed • Maintain confidentiality of health privacy information • Present issues of concern and cite regulatory violations or alleged schemes to defraud the Government • Organize case files and document investigative steps accurately and thoroughly • Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters • Report work activity timely and communicate effectively internally and externally • Work independently and as part of a team with state and federal investigators • Travel approximately 25%, including overnight travel

🎯 Requirements

• 5 years with BS/BA; or 9 years with a HS Diploma/equivalent • Solid investigative experience • Strong communication and organization skills • Strong PC knowledge and skills • Must be able to rent a car and have a valid driver's license • U.S. citizenship required • 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 program and its 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 • Ability to appear in court to testify about work findings • Ability to attend meetings, training, and conferences; overnight travel required

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Life insurance • Health savings account • Short-term disability • Long-term disability • Employee Assistance Program (EAP) • Parental leave • 401(k) • Paid time off (PTO) for vacation • Company-paid holidays • Overtime eligibility • Shift differential eligibility • Discretionary bonus eligibility • Telework available from Florida and Georgia

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