Fraud Investigative Coordinator (SCA)

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 parameters Research and reporting appeals activity to support investigations Ability to perform appeals research using various systems Support with other clerical activities as needed The 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 8-10 Proven strong organizational skills Utilize a personal computer. Proficient in Microsoft Office Sui