[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 work independently with minimum supervision and direction.
• Collaborate with state and/or federal investigators and other personnel as needed.
• 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 when 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: Georgia.

Essential Functions:

• Appear in court to testify about work findings.
• Perform research and draw conclusions.
• Present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government.
• Organize a case file, accurately and thoroughly document all steps taken.
• Compose correspondence, reports, and referral summary letters.
• Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters.
• Communicate effectively, internally and externally.
• Interpret laws and regulations.
• Handle confidential material.
• Report work activity on a timely basis.
• Work independently and as a member of a team to deliver high-quality work.
• Attend meetings, training, and conferences; overnight travel required.

Qualifications

• 5 years with a Bachelor's or 9 years with a HS Diploma/equivalent.
• 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

• Salary range: $66,000 - $106,000.
• Salary determined by various factors, including scope and responsibilities of the position, individual’s experience, education, knowledge, skills, and competencies, geographic location, and business and contract considerations.
• Eligibility for overtime, shift differential, and a discretionary bonus in addition to base pay.

Company Description

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.