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Peraton
Peraton
Sponsor pentru viza H1BAsistență medicalăConsultanțăLogistică
Peraton este o companie de tehnologie pentru întreprinderi, orientată spre misiuni, care deservește clienți din domeniul securității naționale, al armatei și al administrației publice. Activitatea sa acoperă servicii IT și de securitate cibernetică avansate, inclusiv apărare cibernetică, operațiuni în cloud, inginerie, informații și soluții tehnologice bazate pe date. Peraton reunește echipe numeroase și specializate pentru a aborda provocări operaționale și de securitate complexe, prin roluri care sprijină furnizarea de capabilități tehnologice pentru misiuni critice.
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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.

USStatele Unite ale Americii
39.000 $ – 62.000 $ / an
RemoteNormă întreagăJuniorNivel mediuLimbă Obligatorie: englezăGeneralInvestigator de fraude
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Descriere

  • 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.

Cerințe

  • 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.

Beneficii

  • 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.

Locuri de muncă similare

Humana

Humana Provider Contracting Executive (Alabama Market)

Humana
Sponsor pentru viza H1BAsigurare de sănătateAsigurăriAsistență medicală
USStatele Unite ale AmericiiALAlabamaMSMississippiTNTennessee
94.900 $ – 130.500 $ / an
RemoteNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăExecutiv

Negotiate provider agreements and manage network relationships for Humana’s Alabama Market. The remote role covers provider contracting, reimbursement analysis, and network recruitment across the region.

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