Fraud Referral Specialist – Medicare

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $51k - $82k / 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

• Use a variety of tools to evaluate referrals and complaints and develop investigations to identify potential fraud • Respond to referrals from other entities • Field requests for data and support • Analyze and interpret claims data for aberrancies • Conduct interviews • Report findings and take quick, appropriate follow-up actions • Refer cases to field investigative teams or the data team for further analysis • Perform research and draw conclusions • Present concerns, citing regulatory violations and alleging schemes or scams to defraud the Government • Organize case files and accurately document all steps taken • Conduct background investigations on providers within the Medicare program • Compose correspondence, reports, and referral summary letters • Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters • Potentially appear in court to testify about work findings

🎯 Requirements

• 2 years with BS/BA or 6 years with a HS diploma/equivalent • Strong interpersonal, analytical, research, and organizational skills • Excellent verbal and written communications • Strong PC knowledge and skills • Strong use of Excel and ability to sort and filter data • Strong time management and organizational skills • Self-driven and motivated • U.S. citizenship required • 1 or 2 years of investigative or analytical experience preferred • 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, with some overnight travel required

🏖️ Benefits

• Telework available from Florida • Overtime may be available • Shift differential may be available • Discretionary bonus may be available • Some overnight travel required for meetings, training, and conferences