Fraud Referral Specialist – Medicare

🔥 14 hours ago

🏈 Alabama, Florida, +6 more states – Remote

🏈 Alabama – Remote 🐊 Florida – Remote 🌲 North Carolina – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🍑 Georgia – Remote

💵 $39k - $62k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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 issues of concern, 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

🎯 Requirements

• 0 years with BS/BA; 4 years with a high school diploma/equivalent • Strong interpersonal, analytical, research, and organizational skills • Excellent verbal and written communication • 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 • May be required to appear in court to testify about work findings • 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 independently and as a member of a team • Ability to attend meetings, training, and conferences • Some overnight travel required

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Life insurance • Health savings account • Short-term disability • Long-term disability • Employee assistance program (EAP) • Parental leave • 401(k) • Paid time off (PTO) for vacation • Company-paid holidays • Potential eligibility for overtime • Potential eligibility for shift differential • Potential eligibility for a discretionary bonus

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