Remote Fraud Investigations SME Lead

Peraton; Northern (KY); Hybrid; USD 86,000 - 138,000; Full time

Job summary

Peraton's SafeGuard Services is seeking a Fraud Investigative Subject Matter Expert to lead investigations and mentor staff, applying advanced analysis to complex cases in healthcare program integrity. You will coordinate with CMS, law enforcement, and Medicare contractors, provide expert testimony when needed, and help shape investigative strategies while teleworking from anywhere in the United States.

This senior role requires 12+ years with a degree or 16+ years with a HS diploma, deep

Qualifications

• 12+ years with a Bachelor's degree or 16+ years with a HS Diploma.
• Supervisory experience in program integrity investigations.
• Experience with CMS regulations and Medicare claims data.
• Strong knowledge of Medicare regulations, billing practices, and reimbursement methodologies.
• Experience with fraud detection tools, claims analysis, and data mining techniques.
• Understanding of coding systems (ICD-10, CPT, HCPCS).
• Excellent analytical, investigative, and problem-solving skills.
• Strong written and verbal communication abilities, including regulatory reporting.
• Ability to manage sensitive and confidential healthcare information (HIPAA compliance).
• Must be a US Citizen and able to obtain agency clearance.

Responsibilities

• Lead investigations and mentor staff on complex matters.
• Coordinate large-scale fraud investigations and develop cases for action.
• Work with CMS, law enforcement, and Medicare contractors through investigations.
• Apply federal or state laws to investigations and maintain confidentiality of health data.
• Provide expert guidance and testimony in legal and administrative proceedings.
• Develop quality processes and training materials for investigative staff.
• Telework available from anywhere in the United States.

Skills

Investigations leadership

CMS regulations knowledge

Data analysis

HIPAA compliance

Regulatory reporting

Education

Bachelor's degree (or 16 years)

HS Diploma equivalent

Tools

Fraud detection tools

Claims analysis

Data mining

ICD-10 CPT HCPCS coding

Job description

Peraton's SafeGuard Services is seeking a Fraud Investigative Subject Matter Expert to lead investigations and mentor staff, applying advanced analysis to complex cases in healthcare program integrity. You will coordinate with CMS, law enforcement, and Medicare contractors, provide expert testimony when needed, and help shape investigative strategies while teleworking from anywhere in the United States.

This senior role requires 12+ years with a degree or 16+ years with a HS diploma, deep