Fraud Investigator – Medicare

🔥 0 minutes ago

🦌 Connecticut, Maine, +8 more states – Remote

🦌 Connecticut – Remote 🦞 Maine – Remote 🗻 New Hampshire – 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

🦅 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 witnesses and other parties and obtain statements • Complete complex investigative reports applying program 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 investigative results to determine whether allegations are corroborated and recommend appropriate actions • Prepare objective and accurate correspondence • Maintain confidentiality of health privacy information and comply with applicable laws, rules and regulations • Provide training and mentoring on investigative tools and skills • Develop expertise in tools supporting investigations and identify potential fraud schemes • Educate providers, provider associations, law enforcement, contractors and beneficiary advocacy groups on program safeguard matters • Attend meetings, training and conferences • Appear in court to testify about investigative findings when required

🎯 Requirements

• 5 years with BS/BA or 9 years with a HS Diploma/equivalent • 5 to 6 years investigative experience • Strong investigative skills • Strong communication and organization skills • Strong PC knowledge and skills • US Citizenship is required • Ability to perform research and draw conclusions • Ability to organize a case file and accurately and thoroughly document all steps taken • Ability to compose correspondence, reports and referral summary letters • Ability to interpret laws and regulations • Ability to handle confidential material • Ability to manage and prioritize workload effectively so that customer metrics are met or exceeded • Ability to work independently and as a member of a team • Ability to attend meetings, training, conferences, and overnight travel • 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 and/or Medicaid programs and related 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

• Overtime eligibility may be available depending on the position • Shift differential may be available depending on the position • Discretionary bonus may be available depending on the position • Overnight travel opportunities/requirements