3 days old

Fraud Investigator - Medicare

Herndon, VA 20170
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Peraton Overview

Peraton drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the worlds 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 22,000 employees do the cant be done, solving the most daunting challenges facing our customers.

We are an Equal Opportunity/Affirmative Action Employer. We consider applicants without regard to race, color, religion, age, national origin, ancestry, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, veteran status, disability, genetic information, citizenship status, or membership in any other group protected by federal, state, or local law.

As a government contractor, Peraton abides by the following provision

Pay Transparency Nondiscrimination Provision

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of the other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractors legal duty to furnish information. 41 CFR 60-1.35(c).

Qualifications

Prerequisites:
  • BS 5-7 Years, MS 3-5, PhD 0-2
  • Three to five years investigative experience preferred
  • 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

Essential Functions:
  • Ability to communicate effectively, internally and externally
  • 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 interpret laws and regulations
  • 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 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
  • This position may require the incumbent to appear in court to testify about work findings.

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.

Since 1999, SGS has preventedmore than$9.65 billion in inappropriate payments,consisting of nearly $5.98billion in proactively Prevented Dollars and more than $3.69 billion in Recovered Dollars. Our experience with fraud and abuse analytics has resulted in the referral of thousands of cases to law enforcement and resulted in successful criminal and civil prosecution and civil monetary penalties.

Position Overview:

The position requires the individual to use a variety of tools to initiate investigations, identify subjects 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.

For Colorado Residents
Colorado Salary Minimum: $51,251.20
Colorado Salary Maximum:$109,574.40

The estimate displayed represents the typical salary range for this position, and is just one component of Perspecta's total compensation package for employees. Other rewards may include annual bonuses, short- and long-term incentives, and program-specific awards. In addition, Perspecta provides a variety of benefits to employees.

Industry

  • Information Technology
Posted: 2021-06-12 Expires: 2021-07-12

With offerings in mission services, digital transformation and enterprise operations, our team of 14,000 engineers, analysts, investigators and architects work tirelessly to create innovative solutions. We have the expertise and experience not only to devise solutions, but to execute on them successfully.

Sponsored by:
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Fraud Investigator - Medicare

Perspecta
Herndon, VA 20170

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