Fraud Investigations Team Lead

Peraton•,

3d•$66,000 - $106,000•Remote

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. 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 and development of cases for referral to law enforcement or other entities and provide mentoring and guidance to 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. There may be multiple of these individuals for a task order, and they may lead significantly different activities. This role offers telework from the East Coast.

Requirements

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

Nice To Haves

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

Responsibilities

Act as a point of contact for 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 escalating 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 so that they can identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.
Perform research and draw conclusions
Present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
Organize a case file, accurately and thoroughly document all steps taken
Compose correspondence, reports and referral summary letters
Educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters
Interpret laws and regulations