Everett Averhart

Responsibilities:

• Conducted investigations to determine benefit eligibility, entitlement, and payment accuracy for retirement, disability, and Medicare benefits in compliance with federal statutes and policy.
• Analyzed claims data, earnings records, medical and non-medical evidence, and benefit histories to identify improper payments, inconsistencies, and potential fraud indicators.
• Executed investigative plans involving check traces, payment history analysis, and third-party review to resolve missing, misdirected, or incorrect payments.
• Prepared detailed investigative documentation identifying incorrect payees, correct payees, payment amounts, recovery rationale, and supporting evidence in audit-ready case files.
• Initiated overpayment actions, financial recoveries, and replacement payments, tracked recoveries, and diarized cases for required follow-ups.
• Interpreted and applied Medicare enrollment rules, premium calculations, and third-party payer coordination requirements.

Key Achievements:

• Processed approximately 25 cases per day, exceeding standard production expectations by over 250% while maintaining high accuracy.
• Led a 300+ case backlog reduction initiative, improving timeliness, compliance, and audit readiness.
• Identified and documented multiple improper payment scenarios, resulting in corrective actions and financial recoveries.

• Conducted investigative research and document review related to institutional misconduct, policy compliance, and constitutional claims.
• Assisted with interviews and evidence analysis supporting internal investigations and litigation defense.
• Drafted investigative summaries and deposition support materials used by agency attorneys.
• Supported hearings and depositions, gaining exposure to formal investigative and evidentiary procedures.