[Hiring] Complaints/Referrals Team Lead @Peraton

Role Description

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 Complaints/Referrals Team Lead to our SGS team of talented professionals.

As an Investigative Team Lead, this individual’s primary responsibilities include:

• Achieving quality objectives and workload oversight to promote timely development and resolution of investigations.
• Development of cases for referral to law enforcement or other entities.
• Providing mentoring and guidance to the investigative team.
• Exercising significant independent judgment within broadly defined policies and practices.
• Acting as a point of contact for the manager.
• Assisting team members with referral background, analysis, and workflow development.
• Reviewing individual workload during monthly meetings; assisting with prioritization and conducting QC for staff.
• Monitoring the quality of UCM/WMM.
• Monitoring timeliness for case updates and prioritizing referrals and complaints as leads and investigations as necessary.
• Monitoring the progress of complaints and referrals to ensure use of all available remedies.
• Mentoring team members to identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.

Telework available from AL, FL, GA, NC, SC, TN, VA, WV.

Qualifications

• 8 years with a BS/BA or 12 years of experience with a HS Diploma.
• At least 5 years of relevant investigative experience required.
• Strong communication and organization skills.
• Strong leadership background.
• Strong PC knowledge and skills.
• U.S. citizenship required.

Requirements

• Knowledge of Medicare requirements, laws, rules, and regulations related to payment for services billed to the Program.
• Experience in developing leads and investigations, conducting detailed background and link analysis, reviewing claims data, performing medical review, and/or developing fraud cases.

Benefits

• 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 mentor and train others.
• 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.
• Document QC results in WMM according to record type.