Fraud Referral Specialist - Medicare

Peraton Overview

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 do the can’t be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we’re keeping people around the world safe and secure.

Responsibilities

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.

We are looking to add a Fraud Referral Specialist to our SGS team of talented professionals.

What you'll do:

The position requires the individual to use a variety of tools to assist in the evaluation of referrals and complaints, as well as development of investigations to identify potential fraud. Development of investigations commonly include responding to referrals from other entities, fielding requests for data and support, analyzing and interpreting claims data for aberrancies, conducting interviews, and reporting findings with a focus on taking quick and appropriate follow up actions. Follow up actions commonly include referrals to field investigative teams or to the data team for further analysis.

Perform research and draw conclusions

Evaluate complaints and referrals for further investigation

Present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government

Organize a case file, accurately and thoroughly document all steps taken

Conduct background investigation on providers within the Medicare program

Compose correspondence, reports, and referral summary letters

Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters

Telework position avaialble from EST, CST, MST time Zones.

Qualifications

Basic Qualifications:

2 years with a Bachelors or 6 years with a HS diploma/equivalent

At least 2 years of prior experience evaluating complaints or referrals required

Investigative or analytical experience

Strong interpersonal, analytical, research, and organizational skills are required

Excellent verbal and written communications

Strong PC knowledge and skills

Strong use of Excel and being able to sort and filter data

Strong time management and organizational skills required

Self-driven and motivated

U.S. citizenship required

Desirable Qualifications:

The most competitive candidates will have:

This position may require the incumbent to appear in court to testify about work findings.

Ability to communicate effectively, internally, and externally

Ability to interpret laws and regulations

Ability to handle confidential material

Ability to report work activity on a timely basis

Ability to work independently and as a member of a team to deliver high-quality work

Ability to attend meetings, training, and conferences, some overnight travel

Target Salary Range

$51,000 - $82,000. 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

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

EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.

Originally posted on Himalayas