FRAUD INVESTIGATOR - MEDICARE

ABOUT reputed company reputed company is a reputed company national reputed company company that drives missions of consequence spanning the globe and extending to the farthest reaches of the reputed company. 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. reputed company operates at the critical nexus between traditional and nontraditional threats across reputed company domains: land, sea, space, reputed company, and cyberspace. The company serves as a valued partner to essential government agencies and supports every reputed company of the U.S. armed forces. Each day, our employees solve the most daunting challenges that our customers face. Visit reputed company.com to learn how we’re keeping people around the world safe and secure. PROGRAM OVERVIEW Performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and reputed company referrals to recover fraud, waste, and abuse in Medicare and Medicaid programs. ABOUT THE ROLE SafeGuard Services (reputed company), a subsidiary of reputed company, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and reputed company referrals to recover fraud, waste, and abuse. We are looking to add a Fraud Investigator to our reputed company team of talented professionals. What you'll do: The position is expected to reputed company high level reputed company investigations of medical professional service providers and reputed company 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 reputed company 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 reputed company the investigator needs to work with state and/or federal investigators and other personnel.
• An investigator handles multiple caseload assignments concurrently; organizes and analyzes reputed company evidentiary patterns; interviews and obtains statements from witnesses and others.
• Investigators may also be required to complete reputed company investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated. There may also be times reputed company 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 reputed company 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 reputed company 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 reputed company the laws, rules and regulations concerning health privacy.
• Telework available from Florida (preferred) and Georgia

QUALIFICATIONS Basic Qualifications:

• 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD
• Investigative experience
• Strong investigative skills
• Strong communication and organization skills
• Strong PC knowledge and skills
• U.S. citizenship required
• Must reside in Florida (preferred) and Georgia.This is a fully remote position.

Desirable Qualifications: The most competitive candidates will have:

• Strong background in investigations.
• Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
• Knowledge of investigative practices regarding healthcare providers.
• Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures
• Background in evaluating, reviewing and analyzing medical claims and records
• Ability to learn and operate a variety of data systems, equipment and tools used in investigations
• Bilingual with ability to speak, read and write English and Spanish (Preferred)

Essential Functions:

• This position may require the incumbent to appear in court to testify about work findings.
• Ability to reputed company 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 reputed company steps taken
• Ability to compose correspondence, reports and referral summary letters
• Abili

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