Fraud Investigator (Medicaid/Medicare)

Fraud Investigator (Medicaid/Medicare)

Job Locations:USRequisition ID

2024-149803

Position Category

Business Controls

Clearance

No Clearance Required

Responsibilities

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.The

Fraud Investigator

is expected to perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions. Will work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support.An investigator uses good judgment and may work independently with minimum supervision and direction.The investigator also may work as part of a team as there may be times when the investigator needs to work with state and/or federal investigators and other personnel.An investigator handles multiple caseload assignments concurrently; organizes and analyzes complex evidentiary patterns; interviews and obtains statements from witnesses and others.Investigators may also be required to complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated.Investigators are expected to research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations.Investigators then analyze the results of the investigation to ascertain if the allegations have been corroborated and work with others to determine the appropriate steps that need to be taken to address the issues.As part of an investigation, the investigator will need to prepare correspondence; be objective and accurate and communicate with others with tact.There may be times when investigators need to react to unplanned situations, be flexible in planning their activities and adopt effective courses of action.As investigators will be working with health privacy information, they also must maintain confidentiality and understand all the laws, rules and regulations concerning health privacy.Telework available from Maine, New Hampshire, Vermont, New York, Rhode Island, Connecticut, Massachusetts, Pennsylvania, Delaware, District of Columbia, New Jersey, Maryland, Northern Virginia.Qualifications

Basic Qualifications:2 years with BS/BA; 0 years with MS/MA; 6 years with High School diploma2 years investigative experienceKnowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and proceduresKnowledge and experience in the healthcare industry.Strong investigative skillsStrong communication and organization skillsStrong PC knowledge and skillsUS citizenship is requiredPreferred Qualifications:Strong background in investigations.Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud casesKnowledge of investigative practices regarding healthcare providers.Background in evaluating, reviewing and analyzing medical claims and recordsAbility to learn and operate a variety of data systems, equipment and tools used in investigationsEssential Functions:Ability to perform research and draw conclusionsAbility to organize a case file, accurately and thoroughly document all steps takenAbility to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the GovernmentAbility to compose correspondence, reports and referral summary lettersAbility to communicate effectively, internally and externallyAbility to interpret laws and regulationsAbility to handle confidential material.Ability to manage and prioritize workload effectively so that customer metrics are met or exceeded.Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard mattersAbility to work independently and as a member of a team to deliver high quality workAbility to attend meetings, training, and conferences, overnight travel required.This position may require the incumbent to appear in court to testify about work findings.Peraton Overview

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can't be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we're keeping people around the world safe and secure.Target Salary Range

$51,000 - $82,000. This represents the typical salary range for this position based on experience and other factors.

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