Peraton
Peraton
Peraton — ұлттық қауіпсіздік, әскери және мемлекеттік ұйымдар саласындағы клиенттерге қызмет көрсететін, миссияға бағытталған корпоративтік технологиялар компаниясы. Оның қызметі киберқорғаныс, бұлтты операциялар, инженерия, барлау және деректерге негізделген технологиялық шешімдерді қоса алғанда, озық IT және киберқызметтерді қамтиды. Peraton күрделі операциялық және қауіпсіздік мәселелерін шешу үшін ауқымды әрі мамандандырылған командаларды біріктіреді. Бұл командалар аса маңызды миссияларға арналған технологиялық мүмкіндіктерді ұсынуға қолдау көрсететін рөлдерде жұмыс істейді.

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.

Сипаттама

  • 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.

Талаптар

  • 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.

Артықшылықтар

  • 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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