Fraud Investigations Manager - Medicare
About The Position
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 Investigations Manager to our SGS team of talented professionals. What you'll do: This position entails providing direction to a staff of investigators to identify and research issues of potential fraud, waste and abuse. Primary responsibilities include oversight and assistance to the development of cases for referral to law enforcement or other entities and responding to requests for data and support for existing casework.
Requirements
- 10 years of experience, may have supervisory or lead experience
- This position requires proven leadership skills and in-depth knowledge of the Medicare Program as it pertains to reviewing claims and provider behavior for indications of potential fraud, waste and abuse.
- Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program.
- Excellent organizational and communications skills as well as strong PC skills.
- Ability to effectively work independently and as a member of a team
- Possess strong interpersonal skills in motivating a unit and in holding personnel accountable.
- Ability to motivate and mentor a team in conducting well documented, quality investigations.
- Identify areas of fraud, waste or abuse that should be forwarded to law enforcement for further action.
- Effectively manage the day to day management of the workload of a unit, to include conducting quality reviews and/or audits of work as needed
- U.S. citizenship required
- Telework available from Alabama, Florida, Georgia, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia. Florida residency preferred but must reside in one of these states in the SE region.
Responsibilities
- Establish goals, objectives and plans for the unit
- Identifies areas for improvement within the unit, and seeks out additional resources needed to effectively manage a unit
- Motivate staff and evaluate performance and results of a team in order to meet objectives
- Plan resources to address workload needs, set priorities and report unit activity
- Develop, administer, and control a budget
- Administer compensation and other corporate polices
- Recruit and develop staff
- Adapts departmental plans and priorities to address resource and operational challenges
- Identify and solve problems effectively based on changing client needs
- Provide hands on guidance to team members as needed to further the mission
- Utilize strong interpersonal skills to direct the unit
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
