What are the responsibilities and job description for the Fraud Investigator - Medic position at Peraton?
Peraton 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 and highly differentiated national security solutions and technologies that keep people safe and secure. Peraton serves as a valued partner to essential government agencies across the intelligence, space, cyber, defense, civilian, health, and state and local markets. Every day, our employees do the can’t be done, solving the most daunting challenges facing our customers.
Since 1999, SGS has prevented more than $9.65 billion in inappropriate payments, consisting of over $6 billion in proactively Prevented Dollars and more than $3.69 billion in Recovered Dollars. Our experience with conducting fraud and abuse investigations has resulted in the referral of hundreds of cases to law enforcement and resulted in successful criminal and civil prosecution and civil monetary penalties.
Position Overview:
The Fraud Investigator-Medic is expected to perform high level complex investigations of Medicare Part C and D providers and develop cases for future action, including referral to law enforcement, education, and other administrative actions. The position 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 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 statement 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 with 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; detect or verify suspected violations; and 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 the laws, rules, and regulations concerning health privacy.
Prerequisites:
- Bachelor's degree and 5-7 years, Master's degree and 3-5 years, PhD and 0-2 years of experience
- Managed Care or pharmaceutical experience
- Strong investigative skills
- Strong communication and organization skills
- Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
- Strong PC knowledge and skills
- This is a telework position
Essential Functions:
- This position may require the incumbent to appear in court to testify
- Ability to perform research and draw conclusions
- Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
- Ability to organize a case file, accurately and thoroughly document all steps taken
- Ability to compose correspondence, reports and referral summary letters
- Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters
- 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 required
Colorado Salary Maximum:$109,574.40
The estimate displayed represents the typical salary range for this position, and is just one component of Peraton's total compensation package for employees. Other rewards may include annual bonuses, short- and long-term incentives, and program-specific awards. In addition, Peraton provides a variety of benefits to employees.
Salary : $1 - $1,000,000
