Fraud Investigator

• Perform high-level, complex investigations of medical professional service providers
• Develop cases for law-enforcement referral, education, overpayment recovery, and other administrative actions
• Work with internal resources, external agencies, state investigators, and federal investigators to develop cases and corrective actions
• Respond to requests for data and support
• Manage multiple caseload assignments concurrently
• Organize and analyze complex evidentiary patterns
• Interview witnesses and other individuals and obtain statements
• Complete complex investigative reports applying regulations, rules, and federal or state laws
• Research relevant offenses and conduct efficient investigations to detect or verify suspected violations
• Obtain information and evidence through observation, record examination, and interviews
• Analyze investigative results to determine whether allegations are corroborated and recommend appropriate actions
• Prepare objective and accurate correspondence
• Maintain confidentiality of health privacy information and comply with applicable laws, rules, and regulations
• Adapt investigative activities to unplanned situations and changing circumstances
• Educate providers and other stakeholders on program safeguard matters
• Attend meetings, training, and conferences; testify in court when required

Explore Fraud Investigator at Peraton. Review requirements and application details.

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