Fraud Referral Specialist – Medicare

🔥 3 minutes ago

🇺🇸 United States – Remote

💵 $51k - $82k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 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 • 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 • Evaluate complaints and referrals for further investigation • 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

• 2 years with a Bachelor's degree OR 6 years with a high school diploma/equivalent • At least 2 years of prior experience evaluating complaints or referrals • Investigative or analytical experience • Strong interpersonal, analytical, research, and organizational skills • Excellent verbal and written communication skills • Strong PC knowledge and skills • Strong use of Excel, including sorting and filtering data • Strong time management and organizational skills • Self-driven and motivated • U.S. citizenship required • Ability to appear in court to testify about work findings may be required • 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 part of a team • Ability to attend meetings, training, and conferences, including some overnight travel

🏖️ 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 overtime • Shift differential • Discretionary bonus • On-camera interview and identity verification process may be required • Training and conferences, with some overnight travel

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