Responsibilities
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.
What You’ll do:
As an Investigative 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
- Act as a point of contact for manager
- Assist team members with workflow development
- Review individual workload during monthly meetings; assist with prioritization and conduct QC for staff
- Monitor the quality of UCM/WMM
- 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.
- Telework available from EST, CST. MST Time Zone
Qualifications
Basic Qualifications:
- Minimum of 8 years with BS/BA or 12 years with a HS Diploma/equivalent
- Relevant investigative experience required.
- CFE or AHFI certification preferred
- Strong communication and organization skills
- Strong PC knowledge and skills
- US. citizenship required
Preferred Qualifications:
- 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
Essential Functions:
- 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 for periods where the lead is out of the office during work hours.
Target Salary Range$66,000 - $106,000. This represents the typical salary range for this position. 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.
Benefits Statement
Peraton offers eligible employees a variety of benefits including medical, dental, vision, life, health savings account, short/long term disability, EAP, parental leave, 401(k), paid time off (PTO) for vacation, and company paid holidays. A full listing of available benefits can be viewed at https://www.careers.peraton.com/benefits.
Application StatementsThe application period for the job is estimated to be 30 days from the job posting date. However, this timeline may be shortened or extended depending on business needs and the availability of qualified candidates. By applying to this job, you are expressing interest in the role and the Company. During the review of your application, you may be required to participate in an on-camera interview, as well as participate in a process to verify your identity. Use of artificial intelligence (AI) tools of any kind during Peraton interviews is strictly prohibited unless the candidate has obtained prior written authorization. All interview responses must be the candidate’s own.
