[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.

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
• Overpayment recovery
• Other administrative actions

Key responsibilities include:

• Working with internal resources and external agencies to develop cases and corrective actions
• Responding to requests for data and support
• Using good judgment and working independently with minimum supervision
• Collaborating with state and/or federal investigators and other personnel
• Handling multiple caseload assignments concurrently
• Organizing and analyzing complex evidentiary patterns
• Interviewing and obtaining statements from witnesses and others
• Completing complex investigative reports that apply regulations or rules
• Researching and understanding relevant offenses being investigated
• Conducting efficient and effective investigations
• Obtaining information and evidence by observation, record examination, and interview
• Analyzing investigation results to ascertain if allegations have been corroborated
• Preparing correspondence and communicating with others with tact
• Maintaining confidentiality and understanding laws, rules, and regulations concerning health privacy

Telework available from the contiguous U.S., Eastern Time Zone preferred.

Qualifications

• 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

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

Benefits

• Ability 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
• Ability to organize a case file and document all steps taken
• Ability to compose correspondence, reports, and referral summary letters
• Ability to educate providers, provider associations, law enforcement, and 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
• Ability to attend meetings, training, and conferences; overnight travel required