[Hiring] Fraud Investigations 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. As a Fraud Investigator Team Lead, this individual’s primary responsibilities include:

• Achieving quality objectives
• 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

The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives.

What You’ll do:

• Act as a point of contact for the manager
• Assist team members with workflow development
• Review individual workload during monthly meetings; assist with prioritizing and conduct QC for staff
• Monitor the quality of WMM/UCM
• Monitor timeliness for case updates and escalate to management as necessary
• Monitor the progress of investigations and cases to ensure use of all available remedies, i.e., suspension, pre-pay reviews, revocation, etc.
• Mentor team members to identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development
• Telework available from East Coast

Essential Functions Include:

• 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 interpret laws and regulations

Qualifications

• Minimum of 8 years with BS/BA or 12 years of experience with HS Diploma
• Solid investigative experience required
• Strong communication and organization skills
• Strong PC knowledge and skills
• Able to communicate effectively, internally and externally
• Must be a US Citizen

Requirements

• Knowledge of Medicare requirements, laws, rules, and regulations related to payment for services billed to the Program (Preferred)
• Experience in reviewing claims, performing medical review, and/or developing fraud cases (Preferred)
• CFE or AHFI certification a plus (Preferred)

Benefits

• Target Salary Range: $66,000 - $106,000
• Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations
• Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay

Company Description

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can’t be done by solving the most daunting challenges facing our customers.