[Remote] Fraud Referral Specialist – Medicare

Note: The job is a remote job and is open to candidates in USA. Peraton, through its subsidiary SafeGuard Services (SGS), is hiring a Fraud Referral Specialist to evaluate referrals and complaints and develop investigations into potential Medicare fraud. The role involves analyzing claims data, documenting findings, coordinating follow-up actions, and educating stakeholders on program safeguard matters.

Responsibilities

• 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
• 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 available from Florida

Skills

• 0 years with BS/BA; 4 years with a HS Degree
• 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
• 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
• 1 or 2 years of investigative or analytical experience preferred

Benefits

• Telework available from Florida
• Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

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