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Peraton
Peraton
H1B Visa SponsorConsultingHealthcareLogistics
Peraton is a mission-focused enterprise technology company serving national security, military, and government customers. Its work spans advanced IT and cyber services, including cyber defense, cloud operations, engineering, intelligence, and data-driven technology solutions. Peraton brings together large, specialized teams to address complex operational and security challenges, with roles supporting the delivery of technology capabilities for critical missions.
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Fraud Investigator Associate – Healthcare Claims | Peraton Remote

Support Peraton’s healthcare fraud investigations by analyzing medical claims, developing cases, and assisting with recovery and law-enforcement referrals.

USUnited States
$39,000 – $62,000 / year
RemoteFull-timeJuniorMiddleNo degree requiredEnglish RequiredFraud InvestigatorGeneral
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Description

  • Investigate medical professional service providers and support complex healthcare fraud cases.
  • Prepare cases and reports for law-enforcement referrals, provider education, overpayment recovery, and other administrative actions.
  • Assist fraud investigators and auditors with case development, audits, and corrective actions.
  • Collaborate with internal teams, external agencies, state and federal investigators, and other personnel.
  • Respond to requests for data and investigative support.
  • Manage multiple caseload assignments at the same time.
  • Organize and analyze information that supports the team’s workload.
  • Help prepare complex reports by applying regulations and rules to affected programs.
  • Research and understand relevant offenses.
  • Conduct efficient investigations and audits into alleged offenses.
  • Identify or verify suspected violations through observation, record review, and interviews.
  • Analyze investigation and audit findings to determine whether allegations are supported.
  • Help identify appropriate actions for addressing confirmed issues.
  • Draft objective, accurate correspondence and communicate tactfully.
  • Adapt investigative activities and courses of action when unplanned situations arise.
  • Protect confidential health information and follow applicable laws, rules, and regulations.

Requirements

  • No experience with a bachelor’s degree, or four years of experience with a high school diploma or equivalent.
  • Investigative and analytical experience.
  • Strong communication and organizational skills.
  • Strong personal computer knowledge and skills.
  • U.S. citizenship required.
  • Background in investigations or compliance audits preferred for competitive candidates.
  • Experience reviewing claims for technical requirements, conducting medical review, or developing fraud cases and identifying overpayments preferred for competitive candidates.
  • Knowledge of investigative or audit practices involving healthcare providers preferred for competitive candidates.
  • Knowledge of Medicare or Medicaid programs and their rules, regulations, policies, and procedures preferred for competitive candidates.
  • Experience evaluating, reviewing, and analyzing medical claims and records preferred for competitive candidates.
  • Ability to learn and use data systems, equipment, and tools for investigations.
  • Ability to conduct research and draw conclusions.
  • Ability to document investigative or audit workload, present concerns, cite regulatory violations, and allege schemes or scams to defraud the Government.
  • Ability to organize case files and accurately document every step taken.
  • Ability to write correspondence, reports, and referral summary letters.
  • Ability to educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups about program safeguard matters.
  • Ability to communicate effectively with internal and external stakeholders.
  • Ability to interpret laws and regulations.
  • Ability to handle confidential materials.
  • Ability to report work activity promptly.
  • Ability to work under direct supervision as part of a team delivering high-quality work.
  • Ability to attend meetings and training conferences; overnight travel may be required.

Benefits

  • Telework is available from the Eastern Time Zone.
  • Overtime may be available.
  • Shift differential may be available.
  • A discretionary bonus may be available.
  • Peraton is an equal opportunity employer, including for people with disabilities and protected veterans, and prohibits discrimination based on other characteristics protected by law.

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