External Job Posting Title Administrative Action Specialist Team Lead

Peraton; Northern (KY); Hybrid; USD 66,000 - 106,000; Full time

Benefits offered by this job

Telework from East Coast

Job summary

Peraton is seeking an Administrative Action Lead to guide the SGS team in analysis, investigation, and review for action development. You will mentor staff, coordinate with CMS, and ensure timely completion of actions while maintaining compliance with Medicare requirements.

The role emphasizes independent judgment within policy, workload oversight, and high-quality documentation, with telework available from East Coast.

Qualifications

• Minimum of 8 years with BS/BA or 12 years experience with a HS Diploma.
• 8 years of investigative experience required.
• Knowledge of Medicare requirements, laws, rules and regulations related to payment of services billed to the Program.
• Medicare claims processing knowledge.
• Strong communication and organization skills.
• US citizenship required.
• Desirable: CFE or AHFI certification.

Responsibilities

• Act as a point of contact for manager and coordinate with CMS on admin actions.
• Oversee workload and develop/admin action plans, ensuring timely resolution of investigations.
• Mentor team members and provide guidance to investigators on action development.
• Review workloads, conduct QC, and ensure timeliness and quality across actions.
• Monitor quality metrics (WMM/UCM) and escalate issues to management as needed.
• Participate in meetings and CMS high-priority projects; provide team direction.
• Develop efficient workflows and assess process effectiveness.
• Note: Telework available from East Coast.

Skills

Strong communication

US citizenship

Organizational skills

Computer literacy

Education

BS/BA or 12 years experience with HS Diploma

Tools

WMM

CMS

Claims review software

Job description

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 Admin Action Specialist Team Lead to our SGS team of talented professionals.

As an Administrative Action Lead, this individual’s primary responsibilities include achieving quality objectives, workload oversight to promote timely development and resolution of multiple administrative actions within an investigation. Provide mentoring and guidance to the administrative action team as well as guidance to the investigation teams on what is needed to pursue an action. The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives.

What You’ll do:

• Act as a point of contact for manager
• Work with CMS on proceeding with and finalizing administrative actions.
• Assist team members with workflow and admin action development.
• Review individual workloads during workload meetings; assist with prioritizingand conduct QC for staff.
• Monitor the quality of WMM/UCM
• Monitor timeliness for case updates and escalating to management as necessary.
• Monitor the progress ofthe administrative action to ensure all timeframes and metrics are met.
• Mentor team members so that they can proceed efficiently through the development of an action.
• Partake in Investigation requested meetings to discuss admin actions. Partake in CMS' high-priority projects and provide direction to the team.
• Develop an efficient workflow process and evaluate effectiveness
• Telework available from East Coast

Qualifications

Required Qualifications:

• Minimum of 8 years with BS/BA or 12 years of experience and a HS Diploma.
• 8 years of relevant investigative experience required
• Knowledge of Medicare requirements, laws, rules and regulations related to payment of services billed to the Program
• Medicare claims processing knowledge
• Strong communication and organization skills
• Strong PC knowledge and skills
• US citizenship required

Desirable Qualifications:

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

Essential Functions Include:

• 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
• 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 for the team
• 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 may be 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.

Peraton Overview

Peraton 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. Peraton 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 peraton.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.

EEO

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