Senior Advisor - Fraud Analytics PM for Healthcare AI

Remote Jobs; United States; Remote; USD 176,000 - 282,000; Full time

Job summary

Peraton is seeking a Technical Project Manager to act as a Fraud Analytics SME for the FPS2 program supporting CMS. You will drive use-case selection, curate ground-truth data, and align AI outputs with investigator workflows across Medicare/Medicaid fraud detection and adjudication.

You will collaborate with AI engineers and CMS stakeholders to ensure accurate, actionable analytics and dashboards. A strong background in healthcare program integrity and data governance is essential.

Qualifications

• 12+ years with a BS/BA; 10+ years with MS/MA; 7+ years with Ph.D.
• 5+ years working with Medicare and/or Medicaid claims data in a program-integrity, audit, investigative, or fraud-analytics role.
• Deep knowledge of healthcare FWA patterns: billing schemes, coding manipulation, identity/beneficiary fraud, provider collusion.
• Direct CMS program-integrity ecosystem experience: UPICs, MEDICs, MFCUs, HHS-OIG, DOJ, and Federal/State coordination.
• Ability to translate investigator and analyst workflows into use cases and acceptance criteria for analytics or AI teams.
• Familiarity with FPS, IDR, One PI, UCM, or comparable CMS PI systems and their outputs; ability to interpret them.
• Comfort partnering with AI/analytics engineers without coding; domain judgment over implementation.
• Excellent written and verbal communication; able to present findings to CMS stakeholders.

Responsibilities

• Serve as healthcare program-integrity and FWA SME on the AI tool assessment project within FPS.
• Drive FWA use-case selection for the POC, prioritized by fraud impact and analyst value.
• Define and curate ground-truth datasets or investigative reference sets used to evaluate fraud-detection outputs.
• Shape analyst-facing use of Peraton[X] and Rapid FI to reflect real investigator workflows.
• Evaluate AI-generated outputs for factual, clinical, and procedural accuracy; provide analyst feedback to engineering.
• Partner with the Fraud Signals AI Engineer to validate correlations against known fraud patterns.

Skills

Medicare data

Medicaid data

Fraud analytics

CMS ecosystem

Ground-truth datasets

Stakeholder communication

Education

BS/BA

MS/MA

PhD

Tools

SAP BusinessObjects

SAS

Snowflake

Databricks

Web Intelligence

Job description

Peraton is seeking a Technical Project Manager to act as a Fraud Analytics SME for the FPS2 program supporting CMS. You will drive use-case selection, curate ground-truth data, and align AI outputs with investigator workflows across Medicare/Medicaid fraud detection and adjudication.

You will collaborate with AI engineers and CMS stakeholders to ensure accurate, actionable analytics and dashboards. A strong background in healthcare program integrity and data governance is essential.