Fraud Investigator – Medicare

🔥 1 minute ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $66k - $106k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 others and obtain statements • Complete complex investigative reports applying applicable regulations, rules, and laws • Research relevant offenses and conduct investigations to detect or verify suspected violations • Obtain information and evidence through observation, record examination, and interview • Analyze investigation results and determine appropriate corrective steps • Prepare correspondence and referral summary letters • Maintain confidentiality of health privacy information • Conduct site verifications to verify provider operational status • Appear in court to testify about work findings when required • Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters • Report work activity in a timely manner • Attend meetings, training, and conferences

🎯 Requirements

• 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD • Investigative experience • Strong investigative skills • Strong communication and organization skills • Strong PC knowledge and skills • 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 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

🏖️ Benefits

• Telework available from South Florida • Overnight travel required • Employees may be eligible for overtime • Employees may be eligible for shift differential • Employees may be eligible for a discretionary bonus