Fraud Investigations Manager

Remote Jobs; United States; Remote; USD 80,000 - 128,000; Full time

Job summary

SafeGuard Services (SGS), a subsidiary of Peraton, seeks a senior investigator to lead a staff of investigators in identifying and researching Medicare fraud, waste and abuse. You will oversee case development for referral to law enforcement and provide data support for ongoing investigations.

The role requires proven leadership, deep Medicare program knowledge, and the ability to work independently or as part of a team. Telework is available from several US states.

Qualifications

• 10 years of experience, may have supervisory or lead experience.
• In-depth knowledge of the Medicare Program as it pertains to reviewing claims.
• Knowledge of Medicare requirements, laws, rules and regulations related to payment for services.
• Excellent organizational and communications skills and strong PC skills.
• Ability to effectively work independently and as a member of a team
• US citizenship required

Responsibilities

• Provide direction to investigators to identify issues of potential fraud, waste and abuse.
• Oversee development of cases for referral to law enforcement.
• Respond to data requests and support for existing casework.
• Set goals, objectives and plans for the unit.
• Motivate staff and evaluate performance.
• Plan resources, priorities and report unit activity.
• Develop, administer and control a budget.
• Recruit and develop staff.
• Lead a team of investigations and Lead Assessment Investigators.
• Oversee 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

Skills

Leadership

Medicare knowledge

Organizational skills

Communications skills

Teamwork

US citizenship

Education

Bachelor's degree

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.

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

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