Fraud Investigator Associate

Peraton•,

1d•$39,000 - $62,000•Hybrid

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 Investigator Associate is an entry-level investigator/auditor who works under the direct supervision of a team manager and/or team lead. The role supports a team conducting complex investigations of medical professional service providers and developing cases and reports for possible law-enforcement referrals, education, overpayment recovery, and other administrative actions. The associate works with internal resources, external agencies, state and/or federal investigators, and other personnel to develop cases and audits, corrective actions, and responses to data and support requests. The position handles multiple caseload assignments concurrently, organizes and analyzes information, and may assist with complex reports applying program regulations or rules. Working collaboratively with the team, the associate researches relevant offenses, supports effective investigations and audits, helps detect or verify suspected violations, and obtains information and evidence through observation, record examination, and interviews. The associate also helps assess whether allegations are corroborated and determine appropriate responses. The investigator prepares correspondence and communicates objectively, accurately, and tactfully. The role may involve unplanned situations that require flexibility and effective action. Because the work involves health privacy information, the associate must maintain confidentiality and understand applicable health privacy laws, rules, and regulations. Telework is available within the NE UPIC jurisdiction: Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, and Washington, DC.

Requirements

A bachelor’s degree with zero years of experience, or a high school diploma/equivalent with four years of experience.
Investigative and analytical experience.
Strong communication and organizational skills.
Strong PC knowledge and skills.
U.S. citizenship.
Ability to research, draw conclusions, and document information supporting investigative or audit workload.
Ability to organize case files and accurately and thoroughly document actions taken.
Ability to compose correspondence, reports, and referral summary letters.
Ability to communicate effectively internally and externally, interpret laws and regulations, and handle confidential material.
Ability to report work activity on a timely basis and work under direct supervision as part of a team.
Ability to attend meetings and training conferences; overnight travel may be required.

Nice To Haves

Strong background in investigations or compliance audits.
Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments.
Knowledge of investigative or audit practices regarding healthcare providers.
Knowledge of Medicare and/or Medicaid programs and their rules, regulations, policies, and procedures.
Background evaluating, reviewing, and analyzing medical claims and records.
Ability to learn and operate a variety of data systems, equipment, and tools used in investigations.

Responsibilities

Support the team’s investigations and audits of medical professional service providers, including case development, corrective actions, and responses to data and support requests.
Handle multiple caseload assignments concurrently and organize and analyze information in support of team workload.
Assist with complex reports applying regulations or rules to affected programs.
Research relevant offenses and participate in investigations and audits to detect or verify suspected violations.
Obtain information and evidence through observation, record examination, and interviews.
Collaborate with team members to analyze findings, assess whether allegations are corroborated, and determine appropriate steps to address issues.
Prepare correspondence and communicate objectively, accurately, and tactfully.
Maintain confidentiality and follow applicable health privacy laws, rules, and regulations.
Conduct research, draw conclusions, document investigative or audit work, and identify concerns such as regulatory violations or alleged schemes to defraud the Government.
Organize case files and accurately 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.
Interpret laws and regulations, handle confidential materials, and report work activity promptly.
Work under direct supervision as a team member to deliver high-quality work.
Attend meetings and training conferences; overnight travel may be required.