Fraud Investigator – Medicare

🔥 3 minutes ago

🐊 Florida, South Carolina, +1 more states – Remote

🐊 Florida – Remote 🌴 South Carolina – Remote ⚔️ Virginia – Remote

💵 $66k - $106k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚨 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, external agencies, state and federal investigators, and other personnel • Handle multiple caseload assignments concurrently • Organize and analyze complex evidentiary patterns • Interview witnesses and other individuals and obtain statements • Complete investigative reports applying program regulations, rules, and 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 appropriate corrective actions • Prepare objective and accurate correspondence, reports, and referral summary letters • Maintain confidentiality of health privacy information and comply with applicable laws, rules, and regulations • Conduct site verifications to verify provider operational status • Perform field work on a monthly basis, with approximately 25% travel • 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; or 9 years with a HS Diploma/equivalent • 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 (desirable) • Knowledge of investigative practices regarding healthcare providers (desirable) • Knowledge of Medicare program and its rules, regulations, policies and procedures (desirable) • Background in evaluating, reviewing and analyzing medical claims and records (desirable) • Ability to learn and operate a variety of data systems, equipment and tools used in investigations (desirable)

🏖️ Benefits

• Medical, dental, and vision benefits • Life insurance • Health savings account • Short- and long-term disability • Employee assistance program (EAP) • Parental leave • 401(k) • Paid time off (PTO) for vacation • Company-paid holidays • Potential overtime • Shift differential • Discretionary bonus • Overnight travel required for meetings, training, and conferences

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