External Job Posting Title Fraud Investigative Coordinator

Summary

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.We are looking to add a Fraud Investigator Coordinator to our SGS team of talented professionals.What you'll do:This position investigates and takes actions to resolve and/or prevent potential fraud or abuse in the Insurance/Healthcare space.Performs investigations to identify and resolve fraud or abuse. Interviews subjects as part of investigations. Collaborate with law enforcement by referring cases and providing subject matter expertise. Knowledge of claims/reimbursement practices and regulations. Understanding of regulatory environment. Knowledge of investigations processes, tools and practices. Case development and prosecution procedures. Additional activities may include:Receive requests from other entities and prepare appeals documents within specific time parametersResearch and reporting appeals activity to support investigationsAbility to perform appeals research using various systemsSupport with other clerical activities as neededThe position is primarily telework, with the employee located near Camp Hill, PA.On-site presence in Camp Hill, PA office may be required occasionally.Qualifications Basic Qualifications:BS 2-4 Years, MS 0-2 or HS 8-10Proven strong organizational skillsUtilizea personal computer.Proficient in Microsoft Office Suite.Proficient with AdobeAble to lift up to 50 lbs.US. citizenship requiredThe most competitive candidates will have:Ability to search different systems to determine re-reviews of entitiesKnowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and proceduresKnowledge of Medicare Appeals process and different levels of AppealsAbility to learn and operate a variety of data systems, equipment and tools used in investigationsEssential Functions:Ability to perform research and draw conclusionsAbility to organize a case file, accurately and thoroughly document all steps takenAbility to compose correspondence, reports and referral summary lettersAbility to communicate effectively, internally and externallyAbility to interpret laws and regulationsAbility 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 workAbility to attend meetings, training, and conferences, may require overnight travel.Peraton Overview Peraton is a next-generation national security company that 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, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can't be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we're keeping people around the world safe and secure.Target Salary Range $51,000 - $82,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.EEO EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.#J-18808-Ljbffr

Job Description

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.We are looking to add a Fraud Investigator Coordinator to our SGS team of talented professionals.What you'll do:This position investigates and takes actions to resolve and/or prevent potential fraud or abuse in the Insurance/Healthcare space.Performs investigations to identify and resolve fraud or abuse. Interviews subjects as part of investigations. Collaborate with law enforcement by referring cases and providing subject matter expertise. Knowledge of claims/reimbursement practices and regulations. Understanding of regulatory environment. Knowledge of investigations processes, tools and practices. Case development and prosecution procedures. Additional activities may include:Receive requests from other entities and prepare appeals documents within specific time parametersResearch and reporting appeals activity to support investigationsAbility to perform appeals research using various systemsSupport with other clerical activities as neededThe position is primarily telework, with the employee located near Camp Hill, PA.On-site presence in Camp Hill, PA office may be required occasionally.Qualifications Basic Qualifications:BS 2-4 Years, MS 0-2 or HS 8-10Proven strong organizational skillsUtilizea personal computer.Proficient in Microsoft Office Suite.Proficient with AdobeAble to lift up to 50 lbs.US. citizenship requiredThe most competitive candidates will have:Ability to search different systems to determine re-reviews of entitiesKnowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and proceduresKnowledge of Medicare Appeals process and different levels of AppealsAbility to learn and operate a variety of data systems, equipment and tools used in investigationsEssential Functions:Ability to perform research and draw conclusionsAbility to organize a case file, accurately and thoroughly document all steps takenAbility to compose correspondence, reports and referral summary lettersAbility to communicate effectively, internally and externallyAbility to interpret laws and regulationsAbility 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 workAbility to attend meetings, training, and conferences, may require overnight travel.Peraton Overview Peraton is a next-generation national security company that 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, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can't be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we're keeping people around the world safe and secure.Target Salary Range $51,000 - $82,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.EEO EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.#J-18808-Ljbffr