[Hiring] Investigative 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 an Investigative Team Lead to our SGS team of talented professionals.

As an Investigative 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
• Acting as a point of contact for the manager
• Assisting team members with 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 escalating to management as necessary
• Monitoring the progress of investigations and cases to ensure use of all available remedies (e.g., suspension, pre-pay reviews, revocation)
• Mentoring team members to identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development

Telework available in the Eastern Time Zone.

Qualifications

• Minimum of 8 years with BS/BA; Minimum of 6 years with MS/MA; Minimum of 3 years with PhD
• At least 5 years of relevant investigative experience required
• CFE or AHFI certification preferred
• Strong communication and organization skills
• Strong PC knowledge and skills
• US citizenship required

The most competitive candidates will have:

• Knowledge of Medicare requirements, laws, rules, and regulations related to payment for services billed to the Program
• Experience in reviewing claims, performing medical review, and/or developing fraud cases

Requirements

• 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 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
• Coordinate with other designated leads if necessary for coverage during periods where the lead is out of the office during work hours

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.