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Fraud Investigator - Healthcare

Expired Job

Perspecta Inc. Camp Hill , PA 17001

Posted 2 months ago

Fraud Investigator

  • Healthcare Apply Job ID 1686185 Location Camp Hill, Pennsylvania, United States; Liverpool, New York, United States Clearance

Description

Every day at Perspecta, we enable hundreds of thousands of people to take on our nation's most important work. We're a company founded on a diverse set of capabilities and skills, bound together by a single promise: we never stop solving our nation's most complex challenges. Our team of engineers, analysts, developers, investigators, integrators and architects work tirelessly to create innovative solutions. We continually push ourselvesto respond, to adapt, to go further. To look ahead to the changing landscape and develop new and innovative ways to serve our customers.

Perspecta works with U.S. government customers in defense, intelligence, civilian, health care, and state and local markets. Our high-caliber employees are rewarded in many waysnot only through competitive salaries and benefits packages, but the opportunity to create a meaningful impact in jobs and on projects that matter.

Perspecta's talented and robust workforce14,000 strongstands ready to welcome you to the team. Let's make an impact together.

SafeGuard Services (SGS), a subsidiary of Enterprise Services, 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 prevented more than $9.1 billion in inappropriate payments, consisting of over $5.7 billion in proactively Prevented Dollars and $3.4 billion in Recovered Dollars. Our experience with fraud and abuse analytics 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 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.

Essential Functions:

  • This position may require the incumbent to appear in court to testify about work findings.

  • 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

Qualifications

Education and Experience:

Must be a US Citizen or Green Card Holder

  • Bachelor degree preferred and three to five years investigative 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

EEO Tagline: Perspecta is an AA/EEO Employer

  • Minorities/Women/Veterans/Disabled and other protected categories
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VIEW JOBS 12/19/2018 12:00:00 AM 2019-03-19T00:00 Program Integrity Investigator Analyst- HealthcareApply Save job 1686185 Camp Hill, Pennsylvania Description Every day at Perspecta, we enable hundreds of thousands of people to take on our nation's most important work. We're a company founded on a diverse set of capabilities and skills, bound together by a single promise: we never stop solving our nation's most complex challenges. Our team of engineers, analysts, developers, investigators, integrators and architects work tirelessly to create innovative solutions. We continually push ourselves—to respond, to adapt, to go further. To look ahead to the changing landscape and develop new and innovative ways to serve our customers. Perspecta works with U.S. government customers in defense, intelligence, civilian, health care, and state and local markets. Our high-caliber employees are rewarded in many ways—not only through competitive salaries and benefits packages, but the opportunity to create a meaningful impact in jobs and on projects that matter. Perspecta's talented and robust workforce—14,000 strong—stands ready to welcome you to the team. Let's make an impact together. SafeGuard Services (SGS), a subsidiary of Enterprise Services, 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 prevented more than $9.1 billion in inappropriate payments, consisting of over $5.7 billion in proactively Prevented Dollars and $3.4 billion in Recovered Dollars. Our experience with fraud and abuse analytics 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 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. Essential Functions: * This position may require the incumbent to appear in court to testify about work findings. * 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 Qualifications Education and Experience: Must be a US Citizen or Green Card Holder * Bachelor degree preferred and three to five years investigative 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 EEO Tagline: Perspecta is an AA/EEO Employer - Minorities/Women/Veterans/Disabled and other protected categories Perspecta Inc. Camp Hill PA

Fraud Investigator - Healthcare

Expired Job

Perspecta Inc.