Fraud Investigator

🔥 11 minutes ago

🦌 Connecticut, Maine, +9 more states – Remote

🦌 Connecticut – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote

💵 $51k - $82k / 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 • Work independently with minimal supervision and as part of teams with state and/or federal investigators • Manage multiple caseload assignments concurrently • Organize and analyze complex evidentiary patterns • Interview witnesses and other individuals and obtain statements • Prepare complex investigative reports applying program regulations, rules, and applicable federal or state laws • Research relevant offenses and conduct 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 recommend appropriate actions • Prepare correspondence and referral summary letters • Maintain objectivity, accuracy, tact, and confidentiality when handling health privacy information • Adapt investigation plans and respond effectively to unplanned situations • Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters • Manage and prioritize workload to meet or exceed customer metrics

🎯 Requirements

• 2 years with BS/BA; 0 years with MS/MA; 6 years with a HS Diploma/equivalent • Knowledge of Medicare and/or Medicaid programs and related rules, regulations, policies and procedures • Knowledge and experience in the healthcare industry • Strong investigative skills • Strong communication and organization skills • Strong PC knowledge and skills • U.S. citizenship required • Preferred: strong background in investigations • Preferred: experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases • Preferred: knowledge of investigative practices regarding healthcare providers • Preferred: background evaluating, reviewing, and analyzing medical claims and records • Preferred: ability to learn and operate data systems, equipment, and tools used in investigations • Ability to attend meetings, training, and conferences; overnight travel required • May be required to appear in court and testify about work findings

🏖️ Benefits

• Telework available from listed U.S. locations • Overtime eligibility may apply • Shift differential may apply • Discretionary bonus may be available