Fraud Investigator

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $39k - $62k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 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

• Support high-level investigations of medical professional service providers • Develop cases and reports for law-enforcement referrals, education, overpayment recovery and other administrative actions • Support fraud investigators and auditors in developing cases, audits and corrective actions • Work with internal resources, external agencies, state and federal investigators, and other personnel • Respond to requests for data and support • Handle multiple caseload assignments concurrently • Organize and analyze information supporting the team’s workload • Assist with complex reports applying regulations or rules to affected programs • Research and understand relevant offenses • Conduct efficient and effective investigations and audits concerning alleged offenses • Detect or verify suspected violations through observation, record examination and interviews • Analyze investigation and audit results to determine whether allegations are corroborated • Help determine appropriate steps to address identified issues • Prepare objective, accurate correspondence and communicate tactfully • React to unplanned situations and adapt investigative activities and courses of action • Maintain confidentiality of health privacy information and comply with applicable laws, rules and regulations

🎯 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 preferred among competitive candidates • Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments preferred among competitive candidates • Knowledge of investigative or audit practices regarding healthcare providers preferred among competitive candidates • Knowledge of Medicare and/or Medicaid programs and their rules, regulations, policies and procedures preferred among competitive candidates • Background evaluating, reviewing and analyzing medical claims and records preferred among competitive candidates • Ability to learn and operate a variety of data systems, equipment and tools used in investigations • Ability to perform research and draw conclusions • Ability to document information supporting investigative/audit workload, present concerns, cite regulatory violations, and allege 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 in a timely manner • Ability to work under direct supervision as a team member to deliver high-quality work • Ability to attend meetings and training conferences; overnight travel may be required

🏖️ Benefits

• Telework available from Eastern Time Zone • Overtime may be available • Shift differential may be available • Discretionary bonus may be available • Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law