Fraud Investigations Manager

Peraton; Herndon (VA); Remote; USD 80,000 - 128,000; Full time

Benefits offered by this job

Telework eligible

Discretionary bonus

Overtime eligibility

Job summary

Peraton is seeking a Fraud Investigations Manager to guide a team of investigators focused on identifying and addressing fraud, waste and abuse within the Medicare program. The role entails directing case development for referrals to law enforcement and providing data-backed support for ongoing investigations.

Leadership is expected to mentor staff, manage resources and budgets, and ensure compliance with applicable regulations.

Qualifications

• 10+ years of experience in investigations, with supervisory or lead roles.
• In-depth knowledge of Medicare program and claims review for fraud indicators.
• Knowledge of Medicare requirements and billing regulations.
• Strong organizational and communication skills.
• US citizenship required.

Responsibilities

• Provide direction to investigators to identify fraud, waste and abuse.
• Oversee case development for referral to law enforcement or others.
• Respond to data requests and support for ongoing casework.
• Establish unit goals, objectives and plans.
• Motivate staff and evaluate performance.
• Plan resources, set priorities and report unit activity.
• Develop and control a budget.
• Recruit and develop staff.
• Lead investigations and lead assessment investigators.
• Oversee workload to meet contractual requirements.
• Telework available from multiple states.

Skills

Leadership

Medicare knowledge

Data analysis

Communication skills

Independent work

Education

Bachelor's degree

Job description

Fraud Investigations Manager

Job Locations: US

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 a Fraud Investigations Manager to our SGS team of talented professionals

What you'll do:

This position entails providing direction to a staff of investigators to identify and research issues of potential fraud, waste and abuse. Primary responsibilities include oversight and assistance to the development of cases for referral to law enforcement or other entities and responding to requests for data and support for existing casework.

• Establish goals, objectives and plans for the unit
• Motivate staff and evaluate performance
• Plan resources to address workload needs, set priorities and report unit activity
• Develop, administer, and control a budget
• Administer compensation and other corporate polices
• Recruit and develop staff
• Participation in CMS and Law Enforcement Meetings
• Lead a team of investigations and Lead Assessment Investigators
• Oversee and manage workload to meet contractual requirements
• Telework available from Maryland, District of Columbia, Pennsylvania, New Jersey, New York Massachusetts, Connecticut, Vermont, Rhode Island, Maine, Delaware, New Hampshire

Qualifications

Basic Qualifications

• 10 years of experience, may have supervisory or lead experience
• This position requires proven leadership skills and in-depth knowledge of the Medicare Program as it pertains to reviewing claims and provider behavior for indications of potential fraud, waste and abuse.
• Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program.
• Excellent organizational and communications skills as well as strong PC skills.
• Ability to effectively work independently and as a member of a team
• US. citizenship required

Desired Qualifications

• Bachelors degree is a plus

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

$80,000 - $128,000. 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.