Fraud Investigator

About Peraton Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees solve the most daunting challenges that our customers face. Visit peraton.com to learn how we're keeping people around the world safe and secure. Program Overview Performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse in Medicare and Medicaid programs. About The Role 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. What you'll do: The position is expected to perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions. Will work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support. An investigator uses good judgment and may work independently with minimum supervision and direction. The investigator also may work as part of a team as there may be times when the investigator needs to work with state and/or federal investigators and other personnel. An investigator handles multiple caseload assignments concurrently; organizes and analyzes complex evidentiary patterns; interviews and obtains statements from witnesses and others.Investigators may also be required to complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated. There may also be times when the investigator will need to apply federal or state laws. Investigators are expected to 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. Investigators then analyze the results of the investigation to ascertain if the allegations have been corroborated and work with others to determine the appropriate steps that need to be taken to address the issues. As part of an investigation, the investigator will need to prepare correspondence; be objective and accurate and communicate with others with tact. There may be times when investigators need to react to unplanned situations, be flexible in planning their activities and adopt effective courses of action.As investigators will be working with health privacy information, they also must maintain confidentiality and understand all the laws, rules and regulations concerning health privacy.Provide training and mentoring on tools/skills used in the investigative processDevelop expertise in a variety of tools to assist in the development of investigations and to participate in the identification of potential fraud schemes.Telework-Ideally the candidate will be located in Maine, New Hampshire, Vermont, New York, Rhode Island, Connecticut, Massachusetts, Pennsylvania, Delaware, District of Columbia, New Jersey, Maryland, Northern Virginia. Qualifications Qualifications: 5 years with BS/BA; or 9 years investigative experience with high school diplomaStrong investigative skillsStrong communication and organization skillsStrong PC knowledge and skillsUS Citizen The most competitive candidates will have: Strong background in investigations.Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud casesKnowledge of investigative practices regarding healthcare providers.Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and proceduresBackground in evaluating, reviewing and analyzing medical claims and recordsAbility to learn and operate a variety of data systems, equipment and tools used in investigations Essential Functions: Three to five years investigative experience preferredAbility to perform research and draw conclusionsAbility to organize a case file, accurately and thoroughly document all steps takenAbility to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the GovernmentAbility to compose correspondence, reports and referral summary lettersAbility to communicate effectively, internally and externallyAbility to interpret laws and regulationsAbility to handle confidential material.Ability to manage and prioritize workload effectively so that customer metrics are met or exceeded.Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard mattersAbility to work independently and as a member of a team to deliver high-quality workAbility to attend meetings, training, conferences, overnight travel required.This position may require the incumbent to appear in court to testify to work findings. Details Target Salary Range: $66,000 - $106,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay. Benefits Statement: Peraton offers eligible employees a variety of benefits including medical, dental, vision, life, health savings account, short/long term disability, EAP, parental leave, 401(k), paid time off (PTO) for vacation, and company paid holidays. A full listing of available benefits can be viewed at https://www.careers.peraton.com/benefits. Application Statements: The application period for the job is estimated to be 30 days from the job posting date. However, this timeline may be shortened or extended depending on business needs and the availability of qualified candidates. By applying to this job, you are expressing interest in the role and the Company. During the review of your application, you may be required to participate in an on-camera interview, as well as participate in a process to verify your identity. Use of artificial intelligence (AI) tools of any kind during Peraton interviews is strictly prohibited unless the candidate has obtained prior written authorization. All interview responses must be the candidate's own. EEO:Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.