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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, Remote US

Support Peraton’s healthcare fraud, waste, and abuse investigations by reviewing claims, developing cases, and preparing reports for corrective and enforcement actions.

USUnited States
$39,000 – $62,000 / year
RemoteFull-timeJuniorMiddleEnglish RequiredFraud InvestigatorGeneral
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Description

  • Conduct entry-level fraud investigations and audits under the direct guidance of a manager or team lead.
  • Investigate medical professional service providers and develop cases and reports for law enforcement referrals, education, overpayment recovery, and administrative action.
  • Coordinate with internal teams, external agencies, state and federal investigators, and other involved personnel.
  • Manage multiple caseloads simultaneously while organizing and analyzing supporting information.
  • Help prepare complex reports by applying regulations and rules to affected programs.
  • Research relevant offenses and carry out efficient investigations and audits.
  • Identify or validate suspected violations through observation, record review, and interviews.
  • Assess investigation and audit findings to determine whether allegations are substantiated and what corrective actions are appropriate.
  • Draft objective, accurate correspondence and communicate with tact.
  • Protect confidential health information and follow applicable laws, rules, and regulations.
  • Respond to unexpected situations by adjusting plans and selecting effective courses of action.

Requirements

  • No experience with a bachelor’s degree, or four years of experience with a high school diploma or equivalent.
  • Experience in investigation and analysis.
  • Strong communication and organizational abilities.
  • Proficiency with personal computers and related tools.
  • U.S. citizenship is required.
  • A strong background in investigations or compliance audits is especially competitive.
  • Experience reviewing claims for technical requirements, conducting medical reviews, developing fraud cases, or identifying overpayments is especially competitive.
  • Knowledge of investigative or audit practices involving healthcare providers is especially competitive.
  • Knowledge of Medicare or Medicaid programs, rules, regulations, policies, and procedures is especially competitive.
  • Experience evaluating, reviewing, and analyzing medical claims and records is especially competitive.
  • Ability to learn and use the data systems, equipment, and tools required for investigations.
  • Ability to conduct research and reach sound conclusions.
  • Ability to document investigative or audit workloads and cite regulatory violations or alleged fraud schemes.
  • Ability to organize case files and accurately record all steps taken.
  • Ability to write correspondence, reports, and referral summary letters.
  • Ability to interpret laws and regulations.
  • Ability to handle confidential materials.
  • Ability to report work activity on time.
  • Ability to work under direct supervision as part of a team.
  • Ability to attend meetings and training conferences.

Benefits

  • Telework is available from the Eastern Time Zone.
  • Employees may qualify for overtime.
  • Employees may qualify for a shift differential.
  • Employees may qualify for a discretionary bonus.
  • Overnight travel may be required.

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