Investigations Team Lead

Peraton; United States; A distancia; USD 66.000 - 106.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical benefits

Dental benefits

Vision benefits

401(k)

Descripción de la vacante

Peraton is seeking an Investigative Team Lead to oversee investigations in Medicare/Medicaid domains and mentor staff. The role emphasizes quality objectives, timely case development, and referrals to law enforcement or other entities.

Key duties include workload oversight, QC reviews, and development of cases for referrals. Telework is available from EST, CST, and MST time zones, with flexible leadership responsibilities.

Formación

• 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.
• US citizenship required.

Responsabilidades

• Perform research and draw conclusions.
• Present issues of concern, citing regulatory violations and potential fraud.
• Organize a case file and thoroughly document all steps.
• Compose correspondence, reports and referral letters.
• Educate providers, law enforcement, other contractors and beneficiary groups on safeguard matters.
• Communicate effectively, internally and externally.
• Interpret laws and regulations.
• Handle confidential material.
• Report work activity on a timely basis.
• Work independently and as a member of a team to deliver high quality work.
• Attend meetings, training, and conferences; overnight travel may be required.
• Document QC results in WMM according to record type.
• Coordinate with other designated leads for coverage when lead is out of the office.

Conocimientos

Investigative experience

CFE or AHFI

Strong communication

Strong PC knowledge

US citizenship

Descripción del empleo

About Peraton

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 solve the most daunting challenges that our customers face. Visit peraton.com to learn how we’re keeping people around the world safe and secure.

About Peraton

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 solve the most daunting challenges that our customers face. Visit peraton.com to learn how we’re keeping people around the world safe and secure.

Program Overview

Performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse in Medicare and Medicaid programs.

About The Role

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:

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 of investigations 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

Qualifications

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.

Details

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.

Benefits Statement: Peraton offers eligible employees a variety of benefits including medical, dental, vision, life, health savings account, short/long term disability, EAP, parental leave, 401(k), paid time off (PTO) for vacation, and company paid holidays. A full listing of available benefits can be viewed at https://www.careers.peraton.com/benefits.

Application Statements: The application period for the job is estimated to be 30 days from the job posting date. However, this timeline may be shortened or extended depending on business needs and the availability of qualified candidates. By applying to this job, you are expressing interest in the role and the Company. During the review of your application, you may be required to participate in an on-camera interview, as well as participate in a process to verify your identity. Use of artificial intelligence (AI) tools of any kind during Peraton interviews is strictly prohibited unless the candidate has obtained prior written authorization. All interview responses must be the candidate's own.

EEO

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