Fraud Investigator – Medicare

🔥 5 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – 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.

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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 and obtain statements from witnesses and others • Complete complex investigative reports applying regulations or rules to affected programs • Apply federal or state laws as needed • Research and understand relevant offenses • Conduct investigations concerning alleged offenses and detect or verify suspected violations • Obtain information and evidence through observation, record examination, and interview • Analyze investigation results to determine whether allegations are corroborated • Determine appropriate steps with others to address identified issues • Prepare correspondence and communicate objectively, accurately, and tactfully • Maintain confidentiality of health privacy information and comply with applicable laws, rules, and regulations • 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

🎯 Requirements

• 5 years with BS/BA; or 9 years with a HS Diploma • Investigative experience • Strong investigative skills • Strong communication and organization skills • Strong PC knowledge and skills • US 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 • 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 • Ability to attend meetings, training, and conferences • Overnight travel required

🏖️ Benefits

• Telework available from Atlanta, GA area or South Carolina • Employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay • Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law