Fraud Referral Specialist - Medicare
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 Referral Specialist uses a variety of tools to evaluate referrals and complaints and develop investigations to identify potential fraud. The work includes responding to referrals from other entities, handling requests for data and support, analyzing and interpreting claims data for aberrancies, conducting interviews, and reporting findings. Follow-up actions may include referrals to field investigative teams or the data team for further analysis. The role includes researching and drawing conclusions; presenting concerns with citations of regulatory violations and alleged schemes or scams to defraud the Government; organizing case files and thoroughly documenting work; conducting background investigations on Medicare providers; composing correspondence, reports, and referral summary letters; and educating providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters. Telework is available from Alabama, Georgia, Florida, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia.
Requirements
- Bachelor's degree (BS/BA) with no years of experience required, or high school diploma/equivalent with 4 years of experience.
- Strong interpersonal, analytical, research, and organizational skills.
- Excellent verbal and written communication skills.
- Strong PC knowledge and skills.
- Strong Excel skills, including sorting and filtering data.
- Strong time-management and organizational skills.
- Self-driven and motivated.
- U.S. citizenship is required.
Nice To Haves
- 1 or 2 years of investigative or analytical experience is preferred.
- 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; some overnight travel is required.
Responsibilities
- Evaluate referrals and complaints using a variety of tools and develop investigations to identify potential fraud.
- Respond to referrals from other entities and field requests for data and support.
- Analyze and interpret claims data to identify aberrancies.
- Conduct interviews and report findings, taking quick and appropriate follow-up actions.
- Refer matters to field investigative teams or the data team for further analysis as appropriate.
- Conduct research and draw conclusions.
- Present issues of concern, citing regulatory violations and alleging schemes or scams to defraud the Government.
- Organize case files and accurately and thoroughly document all steps taken.
- Conduct background investigations on providers within the Medicare program.
- Compose correspondence, reports, and referral summary letters.
- Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters.
- Attend meetings, training, and conferences; some overnight travel is required.
- The position may require appearing in court to testify about work findings.
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 depending on the position.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
