Fraud Investigator – Medicare

🔥 45 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.

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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 • Work independently with minimal supervision and direction • Collaborate with state and/or 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 complex investigative reports applying applicable program regulations and 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 to determine whether allegations are corroborated and appropriate corrective steps • Prepare objective and accurate correspondence • 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 • Attend meetings, training, and conferences, including overnight travel

🎯 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 • 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 and 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 • Desirable: Strong background in investigations • Desirable: Experience 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 rules, regulations, policies, and procedures • Desirable: Background 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

🏖️ Benefits

• Medical, dental, and vision insurance • Life insurance • Health savings account • Short-term and 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, South Carolina, or Virginia

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