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Fraud Investigator – Medicare
| Company | Peraton |
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| Location | Florida, USA |
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| Salary | $66000 – $106000 |
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| Type | Full-Time |
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| Degrees | Bachelor’s |
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| Experience Level | Junior, Mid Level |
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Requirements
- 2 years with BS/BA; 0 years with MS/MA; 6 years with no degree
- Investigative experience
- Strong investigative skills
- Strong communication and organization skills
- Strong PC knowledge and skills
- U.S. citizenship required
Responsibilities
- Perform high level complex investigations of medical professional service providers
- Develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions
- Work with internal resources and external agencies to develop cases and corrective actions
- Respond to requests for data and support
- Organize and analyze complex evidentiary patterns
- Interview and obtain statements from witnesses and others
- Complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated
- Research and understand the relevant offenses being investigated
- Conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations
- Obtain information and evidence by observation, record examination, and interview
- Analyze the results of the investigation to ascertain if the allegations have been corroborated
- Prepare correspondence; be objective and accurate and communicate with others with tact
- React to unplanned situations, be flexible in planning activities and adopt effective courses of action
- Maintain confidentiality and understand all the laws, rules and regulations concerning health privacy
Preferred Qualifications
- Strong background in investigations
- Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
- Knowledge of investigative practices regarding healthcare providers
- Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures
- Background in evaluating, reviewing and analyzing medical claims and records
- Ability to learn and operate a variety of data systems, equipment and tools used in investigations
- Telework from Florida preferred
