Fraud Investigative Coordinator

Peraton•Rayne Township, PA

5d•$51,000 - $82,000•Remote

About The Position

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 Coordinator to our SGS team of talented professionals. This position investigates and takes actions to resolve and/or prevent potential fraud or abuse in the Insurance/Healthcare space. Performs investigations to identify and resolve fraud or abuse. Interviews subjects as part of investigations. Collaborate with law enforcement by referring cases and providing subject matter expertise. Knowledge of claims/reimbursement practices and regulations. Understanding of regulatory environment. Knowledge of investigations processes, tools and practices. Case development and prosecution procedures. Additional activities may include: Receive requests from other entities and prepare appeals documents within specific time parameters. Research and reporting appeals activity to support investigations. Ability to perform appeals research using various systems. Support with other clerical activities as needed. The position is primarily telework, with the employee located near Camp Hill, PA. On-site presence in Camp Hill, PA office may be required occasionally.

Requirements

BS 2-4 Years, MS 0-2 or HS 8-10
Proven strong organizational skills
Utilize a personal computer.
Proficient in Microsoft Office Suite.
Proficient with Adobe
Able to lift up to 50 lbs.
US. citizenship required
Ability to learn and operate a variety of data systems, equipment and tools used in investigations

Nice To Haves

Ability to search different systems to determine re-reviews of entities
Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures
Knowledge of Medicare Appeals process and different levels of Appeals

Responsibilities

Investigates and takes actions to resolve and/or prevent potential fraud or abuse in the Insurance/Healthcare space.
Performs investigations to identify and resolve fraud or abuse.
Interviews 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 specific time parameters.
Research and reporting appeals activity to support investigations.
Perform appeals research using various systems.
Support with other clerical activities as needed.
Ability to perform research and draw conclusions.
Ability to organize a case file, accurately and thoroughly document all steps taken.
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 to deliver high-quality work.
Ability to attend meetings, training, and conferences, may require overnight travel.