[Hiring] Fraud Investigator Associate @Peraton

Role Description

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. We are looking to add a Fraud Investigator Associate to our SGS team of talented professionals.

The position is an entry level fraud investigator/auditor position expected to work under the direct supervision of a team manager and/or team lead. The team performs high level complex investigations of medical professional service providers and develops cases/reports for future action, including referral to law enforcement, education, over payment recovery and other administrative actions.

• The investigator uses good judgment and will work under the direct supervision of team manager and/or team lead.
• The investigator/audit associate will work in support of a team who works with state and/or federal investigators and other personnel.
• The investigator handles multiple caseload assignments concurrently; organizes and analyzes information in support of the team’s workload.
• The Investigator may also be required to assist in the completion of complex reports that apply regulations or rules to the program(s) affected by the behavior being reviewed.
• Investigator will work collaboratively within the team and participate in researching and understanding the relevant offenses being reviewed.
• Participate in conducting efficient and effective investigations/audits concerning those alleged offenses and detect or verify suspected violations.
• Obtain information and evidence by observation, record examination, and interview.
• Collaborate with team members to analyze the results of the investigation/audit to ascertain if the allegations have been corroborated.
• Prepare correspondence; be objective and accurate and communicate with others with tact.
• React to unplanned situations, be flexible in planning activities and adopt effective courses of action.
• Maintain confidentiality and understand all the laws, rules and regulations concerning health privacy.

Telework available from NE UPIC jurisdiction (Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, and the District of Columbia (Washington, DC).

Qualifications

• 0 years’ experience with BS/BA, 4 years’ experience with a HS diploma/equivalent.
• Investigative and analytical experience.
• Strong communication and organization skills.
• Strong PC knowledge and skills.
• U.S. citizenship required.

Requirements

• Strong background in investigations or compliance audits.
• Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments.
• Knowledge of investigative or audit practices regarding healthcare providers.
• Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures.
• Background in evaluating, reviewing and analyzing medical claims and records.
• Ability to learn and operate a variety of data systems, equipment and tools used in investigations.

Benefits

• Medical, dental, vision, life insurance.
• Health savings account.
• Short/long term disability.
• EAP (Employee Assistance Program).
• Parental leave.
• 401(k) plan.
• Paid time off (PTO) for vacation.
• Company paid holidays.

Target Salary Range

$39,000 - $62,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.