Fraud Investigator

🔥 16 hours ago

🦌 Connecticut, Maine, +8 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

💵 $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, provider education, overpayment recovery, and other administrative actions • Work with internal resources, external agencies, state investigators, and federal investigators to develop cases and corrective actions • Respond to requests for data and support • Handle multiple caseload assignments concurrently • Organize and analyze complex evidentiary patterns • Interview witnesses and other parties and obtain statements • Prepare complex investigative reports applying regulations, rules, and applicable federal or state laws • Research relevant offenses and investigate alleged violations • Obtain information and evidence through observation, record examination, and interviews • Analyze investigation results to determine whether allegations are corroborated • Determine appropriate steps to address identified issues • Prepare correspondence and referral summary letters • Maintain objectivity, accuracy, tact, and confidentiality when handling health privacy information • Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters • Attend meetings, training, and conferences; travel overnight as required • Appear in court to testify about work findings when required

🎯 Requirements

• 2 years with BS/BA or 6 years with a HS Diploma/equivalent • Knowledge of Medicare and/or Medicaid programs and their 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 • US citizenship is required • Ability to perform research and draw conclusions • Ability to organize a case file and accurately document all steps taken • Ability to interpret laws and regulations • Ability to handle confidential material • Ability to manage and prioritize workload effectively • Ability to work independently and as a member of a team • Ability to attend meetings, training, conferences, and required overnight travel • Strong background in investigations • Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases • Knowledge of investigative practices regarding healthcare providers • Background evaluating, reviewing, and analyzing medical claims and records • Ability to learn and operate data systems, equipment, and tools used in investigations

🏖️ Benefits

• Telework available from specified states and District of Columbia • Overtime eligibility may be available • Shift differential may be available • Discretionary bonus may be available