[Hiring] Fraud Investigator @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 to our SGS team of talented professionals.

What you'll do:

• Perform high level complex investigations of medical professional service providers.
• Develop cases for future action, including referral to law enforcement, education, overpayment recovery, and other administrative actions.
• Work with internal resources and external agencies to develop cases and corrective actions.
• Respond to requests for data and support.
• Use good judgment and may work independently with minimum supervision and direction.
• Collaborate with state and/or federal investigators and other personnel.
• Handle multiple caseload assignments concurrently.
• Organize and analyze complex evidentiary patterns.
• Interview and obtain statements from witnesses and others.
• Complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated.
• Apply federal or state laws as necessary.
• Research and understand the relevant offenses being investigated.
• Conduct efficient and effective investigations concerning alleged offenses.
• Detect or verify suspected violations.
• Obtain information and evidence by observation, record examination, and interview.
• Analyze the results of the investigation to ascertain if the allegations have been corroborated.
• Prepare correspondence; be objective and accurate; communicate with others with tact.
• React to unplanned situations and be flexible in planning activities.
• Maintain confidentiality and understand all laws, rules, and regulations concerning health privacy.

Telework available from Florida (preferred) and Georgia.

Qualifications

• 7 years with AS/AA; 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD.
• Investigative experience.
• Strong investigative skills.
• Strong communication and organization skills.
• Strong PC knowledge and skills.
• U.S. citizenship required.
• Must reside in Florida (preferred) and Georgia. This is a fully remote position.

Requirements

• Strong background in investigations.
• Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases.
• Knowledge of investigative 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.
• Bilingual with ability to speak, read, and write English and Spanish (Preferred).

Benefits

• This position may require the incumbent to appear in court to testify about work findings.
• Ability to perform research and draw conclusions.
• Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government.
• Ability to organize a case file, accurately and thoroughly document all steps taken.
• Ability to compose correspondence, reports, and referral summary letters.
• Ability to educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters.
• Ability to communicate effectively, internally and externally.
• 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 to deliver high-quality work.
• Ability to attend meetings, training, and conferences; overnight travel required.