Investigations Team Lead

Peraton•,

14d•$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, and reduce fraud, waste, and abuse, and to make referrals for recovery. The Investigative Team Lead helps achieve quality objectives, oversees workloads to support timely investigation development and resolution, develops cases for referral to law enforcement or other entities, and mentors and guides investigative staff. The role requires significant independent judgment within broadly defined policies and practices to select methods for accomplishing work and meeting objectives. Multiple team leads may serve on a task order and lead different activities. Telework is available in the EST, CST, and MST time zones.

Requirements

At least 8 years of experience with a bachelor's degree, or 12 years of experience with a high school diploma or equivalent.
Relevant investigative experience.
Strong communication and organizational skills.
Strong PC knowledge and skills.
U.S. citizenship.
Ability to perform research and draw conclusions.
Ability to present concerns, cite regulatory violations, and allege schemes or scams to defraud the Government.
Ability to organize case files and 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 and handle confidential material.
Ability to report work activity on a timely basis.
Ability to work independently and as part of a team to deliver high-quality work.
Ability to attend meetings, training, and conferences; overnight travel is required.

Nice To Haves

Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) certification.
Knowledge of Medicare requirements, laws, rules, and regulations related to payment for services billed to the Program.
Experience reviewing claims, performing medical review, and/or developing fraud cases.

Responsibilities

Serve as a point of contact for the manager.
Assist team members with workflow development.
Review individual workloads during monthly meetings, assist with prioritization, and conduct quality control for staff.
Monitor the quality of UCM/WMM.
Monitor the timeliness of case updates and escalate issues to management as necessary.
Monitor investigation and case progress to ensure use of available remedies, including suspension, pre-pay reviews, and revocation.
Mentor team members in identifying previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.
Document quality-control results in WMM according to record type.
Coordinate with other designated leads to arrange coverage when away from the office during work hours.