Peraton · 4 hours ago

Fraud Investigator

United States

Full-time

Remote

Entry, Mid Level

$51K/yr - $82K/yr

2+ years exp

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Information TechnologyRobotics

Actively Hiring

No H1B

U.S. Citizen Only

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Responsibilities

The Fraud Investigator is expected to perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions.

Will work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support.

An investigator uses good judgment and may work independently with minimum supervision and direction.

The investigator also may work as part of a team as there may be times when the investigator needs to work with state and/or federal investigators and other personnel.

An investigator handles multiple caseload assignments concurrently; organizes and analyzes complex evidentiary patterns; interviews and obtains statements from witnesses and others.

Investigators may also be required to complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated.

There may also be times when the investigator will need to apply federal or state laws.

Investigators are expected to research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview.

Investigators then analyze the results of the investigation to ascertain if the allegations have been corroborated and work with others to determine the appropriate steps that need to be taken to address the issues.

As part of an investigation, the investigator will need to prepare correspondence; be objective and accurate and communicate with others with tact.

There may be times when investigators need to react to unplanned situations, be flexible in planning their activities and adopt effective courses of action.

As investigators will be working with health privacy information, they also must maintain confidentiality and understand all the laws, rules and regulations concerning health privacy.

Qualification

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Investigative experienceMedicareMedicaidPC knowledgeExperience in medical reviewHealthcare investigationsLearn data systemsPerform researchPresent issuesOrganize case filesCompose reportsEducate stakeholdersInterpret lawsHandle confidential materialReport activityAttend meetings