Fraud Investigator

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $39k - $62k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 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 entry-level fraud investigations and audits under the direct supervision of a team manager and/or team lead • Support investigations of medical professional service providers and develop cases and reports for law enforcement referrals, education, overpayment recovery and administrative actions • Work with internal resources, external agencies, state and federal investigators, and other personnel • Handle multiple caseload assignments concurrently and organize and analyze supporting information • Assist with complex reports applying regulations or rules to affected programs • Research and understand relevant offenses and conduct efficient investigations and audits • Detect or verify suspected violations through observation, record examination and interviews • Analyze investigation/audit results to determine whether allegations are corroborated and appropriate corrective actions • Prepare objective, accurate correspondence and communicate tactfully • Maintain confidentiality of health privacy information and comply with applicable laws, rules and regulations • React to unplanned situations, adjust plans and adopt effective courses of action

🎯 Requirements

• 0 years’ experience with BS/BA, or 4 years’ experience with a HS diploma/equivalent • Investigative and analytical experience • Strong communication and organization skills • Strong PC knowledge and skills • US. citizenship required • Strong background in investigations or compliance audits (most competitive candidates) • Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments (most competitive candidates) • Knowledge of investigative or audit practices regarding healthcare providers (most competitive candidates) • Knowledge of Medicare and/or Medicaid programs and rules, regulations, policies and procedures (most competitive candidates) • Background in evaluating, reviewing and analyzing medical claims and records (most competitive candidates) • Ability to learn and operate a variety of data systems, equipment and tools used in investigations • Ability to research and draw conclusions • Ability to document investigative/audit workload and cite regulatory violations or alleged fraud schemes • Ability to organize a case file and accurately 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 report work activity timely • Ability to work under direct supervision as a team member • Ability to attend meetings and training conferences

🏖️ Benefits

• Telework available from Eastern Time Zone • Employees may be eligible for overtime • Employees may be eligible for shift differential • Employees may be eligible for a discretionary bonus • Overnight travel may be required