Investigations Team Lead

Peraton; Fort Meade (MD); Remote; USD 90,000 - 130,000; Full time

Job summary

SafeGuard Services (SGS), a Peraton subsidiary, is seeking an Investigative Team Lead to guide a skilled team in detecting fraud, waste, and abuse. The role emphasizes quality, timely investigation development, and collaboration with law enforcement or other entities.

The ideal candidate has substantial investigative experience, strong communication, and the ability to educate providers and stakeholders on program safeguard matters. Telework options are available within EST/CST time zones.

Qualifications

• Minimum 8 years with BS/BA or 12 years with 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.

Responsibilities

• Lead investigative team to achieve quality objectives and timely development of investigations.
• Mentor team members and manage workload to ensure timely case resolution.
• Develop cases for referral to law enforcement or other entities.
• Document QC results and coordinate with leads for coverage when out of office.
• Communicate findings to providers, law enforcement, and other stakeholders.
• Attend meetings, trainings, and conferences as required; remote work possible.

Skills

Investigative experience

Communication skills

Leadership

Regulatory knowledge

Education

BS/BA or higher

HS Diploma

Tools

WMM

UCM

Job description

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.

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 ofinvestigations 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