Complaints/Referrals Team Lead - Medicare

Peraton; United States; Remote; USD 66,000 - 106,000; Full time

Job summary

Peraton is seeking an Investigative Team Lead for SafeGuard Services (SGS) to oversee complaints and referrals investigations, develop cases for referral, and mentor investigators. Responsibilities include quality objectives, workload oversight, and guiding staff through complex analyses of referrals and complaints to uncover fraud, waste, or abuse.

The role requires strong leadership, exceptional communication, and the ability to work independently within policy frameworks.

Qualifications

• 8 years with a BS/BA or 12 years with a HS Diploma.
• At least 5 years of relevant investigative experience.
• Strong communication and organization skills.
• Strong leadership background.
• Strong PC knowledge and skills.
• U.S. citizenship required.

Responsibilities

• Act as a point of contact for manager.
• Assist team members with background, analysis, and workflow development for referrals.
• Review workload during monthly meetings; assist with prioritization and QC for staff.
• Monitor the quality of UCM/WMM.
• Monitor timeliness for case updates and prioritize referrals and complaints as leads and investigations as necessary.
• Monitor progress of complaints and referrals to ensure use of all remedies, transfer to field investigations, and make recommendations for further review.
• Mentor team members to identify fraud, waste, or abuse through research, analysis, and development.

Skills

Strong communication

Organization

Leadership

PC knowledge

Education

BS/BA

HS Diploma

Job description

ResponsibilitiesSafeGuard Services (SGS), a subsidiary of the company, 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 Complaints/Referrals 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, specifically in the analysis and review of referrals and complaints that are received.

• Act as a point of contact for manager
• Assist team members with referral background, analysis, and 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 prioritize referrals and complaints as leads and investigations as necessary
• Monitor the progress of complaints and referrals to ensure use of all available remedies, transfer to field investigations, and make recommendations for further review
• 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 AL, FL, GA, NC, SC, TN, VA, WV

QualificationsBasic Qualifications:

• 8 years with a BS/BA or 12 years of experience with a HS Diploma
• At least 5 years of relevant investigative experience required.
• Strong communication and organization skills
• Strong leadership background
• Strong PC knowledge and skills
• U.S. citizenship required

Desirable Qualifications:

• Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program
• Experience in developing leads and investigations, conducting detailed background and link analysis, reviewing claims data, 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 mentor and train others
• 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

the company OverviewPeraton 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. the company 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. Visit the company.com to learn how we’re keeping people around the world safe and secure.

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.EEOEEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.