Fraud Investigator Associate

Peraton•,

1d•$39,000 - $62,000•Remote

About The Position

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and refer fraud, waste, and abuse 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 teams conducting complex investigations of medical professional service providers and developing cases and reports for potential law-enforcement referrals, education, overpayment recovery, and other administrative actions. The associate works with internal resources and external agencies to develop investigations, audits, and corrective actions, and responds to requests for data and support. The position requires handling concurrent caseload assignments, organizing and analyzing information, and collaborating with investigators, auditors, and state or federal personnel. The associate may assist with complex reports applying regulations or rules to affected programs. Work includes researching alleged offenses; assisting with investigations and audits to detect or verify suspected violations; obtaining information and evidence through observation, record examination, and interviews; analyzing findings with team members; and helping determine appropriate responses. The investigator also prepares objective, accurate correspondence and communicates tactfully. Flexibility may be needed to respond to unplanned situations. Because the role involves health privacy information, the associate must maintain confidentiality and understand applicable privacy laws, rules, and regulations. Telework is available from the NE UPIC jurisdiction: Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, and the District of Columbia.

Requirements

Bachelor's degree (BS/BA) with 0 years of experience, or high school diploma/equivalent with 4 years of experience.
Investigative and analytical experience.
Strong communication and organization skills.
Strong PC knowledge and skills.
U.S. citizenship required.
Ability to perform research and draw conclusions.
Ability to document investigative or audit work, organize case files, compose correspondence and reports, and report work activity on time.
Ability to communicate effectively internally and externally, interpret laws and regulations, and handle confidential material.
Ability to work under direct supervision as a member of a team.

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 data systems, equipment, and tools used in investigations.

Responsibilities

Support teams conducting investigations and audits of medical professional service providers and developing cases and reports for potential law-enforcement referrals, education, overpayment recovery, and other administrative actions.
Work with internal resources, external agencies, and state and/or federal investigators and personnel to develop cases, audits, and corrective actions and respond to requests for data and support.
Handle multiple caseload assignments concurrently and organize and analyze information supporting the team's workload.
Assist with complex reports applying regulations or rules to affected programs.
Research and understand relevant alleged offenses and participate in efficient 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 investigation or audit results, assess whether allegations are corroborated, and determine appropriate next steps.
Prepare objective and accurate correspondence and communicate with others tactfully.
Maintain confidentiality and comply with applicable health privacy laws, rules, and regulations.
Research information and draw conclusions; document investigative and audit work, issues of concern, and alleged regulatory violations or schemes to defraud the Government.
Organize case files and accurately and thoroughly document actions 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 material, and report work activity in a timely manner.
Work under direct supervision as a team member to deliver high-quality work.
Attend meetings and training conferences; overnight travel may be required.

Benefits

Medical insurance
Dental insurance
Vision insurance
Life insurance
Health savings account
Short- and long-term disability
Employee assistance program (EAP)
Parental leave
401(k)
Paid time off (PTO) for vacation
Company-paid holidays
Employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.