Fraud Investigative Coordinator

Peraton•Home, PA

4d•Remote

About The Position

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, and reduce fraud, waste, and abuse, and to make referrals for recovery. The Fraud Investigative Coordinator investigates potential fraud or abuse in the insurance and healthcare space and takes action to resolve or prevent it. The position is primarily telework, with the employee located near Camp Hill, Pennsylvania. Occasional on-site presence at the Camp Hill office may be required. Meetings, training, and conferences may require overnight travel.

Requirements

Bachelor’s degree and 2–4 years of experience, master’s degree and 0–2 years of experience, or high school diploma and 8–10 years of experience.
Strong organizational skills.
Ability to use a personal computer.
Proficiency with Microsoft Office Suite.
Proficiency with Adobe.
Ability to lift up to 50 pounds.
U.S. citizenship required.
Knowledge of claims and reimbursement practices and regulations.
Understanding of the regulatory environment.
Knowledge of investigation processes, tools, and practices.
Knowledge of case development and prosecution procedures.
Ability to perform research and draw conclusions.
Ability to organize case files and document work accurately and thoroughly.
Ability to compose correspondence, reports, and referral summary letters.
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.

Nice To Haves

Ability to search different systems to determine re-reviews of entities.
Knowledge of Medicare and/or Medicaid programs, including their rules, regulations, policies, and procedures.
Knowledge of the Medicare Appeals process and its different levels.
Ability to learn and operate a variety of data systems, equipment, and tools used in investigations.

Responsibilities

Investigate potential fraud or abuse and take action to resolve or prevent it.
Interview subjects as part of investigations.
Collaborate with law enforcement by referring cases and providing subject matter expertise.
Receive requests from other entities and prepare appeals documents within specified time parameters.
Research and report on appeals activity to support investigations.
Conduct appeals research using various systems.
Provide clerical support as needed.
Research information and draw conclusions.
Organize case files and accurately document all steps taken.
Compose correspondence, reports, and referral summary letters.
Communicate effectively with internal and external audiences.
Interpret laws and regulations.
Handle confidential material.
Report work activity in a timely manner.
Work independently and as part of a team to deliver high-quality work.
Attend meetings, training, and conferences, including occasions that may require overnight travel.