Peraton · 18 hours ago
Fraud Investigator Admin Action
United States
Full-time
Remote
Mid Level
$51K/yr - $82K/yr
4+ years expPeraton is a next-generation national security company that drives missions of consequence spanning the globe. They are seeking a Fraud Investigator Admin Action Specialist to perform data analysis, investigation, and medical review to detect and prevent fraud, waste, and abuse in Medicare and Medicaid programs.
Information TechnologyRobotics
No H1B
U.S. Citizen Only
Responsibilities
Review and verify evidence supporting an administrative action as it relates to payment suspensions, revocations, overpayments as well as other administrative actions that can be pursued
Work with the Investigations, Medical Review and Data teams to ensure that the documentation gathered is sufficient to support an administrative action
Making administrative action recommendation to Investigations and CMS
Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action
Monitor workload to ensure all actions are taken within the required timeframes set forth in the Program Integrity Manual
Prepare and submit administrative action packages to CMS and the MACs for approval and processing and speak to the action development
Ensure that all timelines are followed
Qualification
Required
4 years with AS/AA; 2 years with BS/BA; 0 years with MS/MA; 6 years with High School diploma/equivalent in lieu degree
Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program
Strong critical thinking, communication, writing and organizational skills
Experience in developing fraud cases
Strong PC knowledge and skills
Knowledge of Medicare systems
Ability to perform research and draw conclusions
Ability to present issues of concern, citing and interpreting regulatory violations
Ability to organize a case file, accurately and thoroughly document all steps taken
Ability to compose correspondence, reports and letters clearly and concisely
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, overnight travel may be required
US citizenship required
Preferred
Medicare fraud investigation and/or Medicare billing background
Investigation
CFE or AHFI certification
Benefits
Medical
Dental
Vision
Life
Health savings account
Short/long term disability
EAP
Parental leave
401(k)
Paid time off (PTO) for vacation
Company paid holidays
Company
Peraton
Peraton Fearlessly solving the toughest national security challenges.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Thomas Terjesen
Chief Information Officer
Recent News
Washington Technology
2026-01-22
2025-09-25
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