Senior Fraud Investigative SME - Telework Eligible

Peraton; Northern (KY); Hybrid; USD 120,000 - 165,000; Full time

Benefits offered by this job

Telework available nationwide

Job summary

Peraton, via its SafeGuard Services (SGS) division, is seeking a Fraud Investigative Subject Matter Expert to lead complex investigations and mentor a team of investigators.

The role focuses on advanced analysis, cross-team collaboration, and testimony readiness, with telework options nationwide in the United States and close coordination with CMS, law enforcement, and government contractors.

Qualifications

• Minimum of 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
• Must be able to obtain and maintain the required agency clearance.

Responsibilities

• Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action.
• Apply federal or state laws to investigations.
• Work with health privacy information, maintain confidentiality and understand all the laws, rules and regulations concerning health privacy.
• Present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government.
• Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters.
• The position is expected to provide subject matter expertise on investigative strategies for the most highly complex investigations of medical professional service providers.
• Participate in the coordination of large-scale multi-subject fraud schemes/investigations, including referrals to law enforcement and recovery actions.
• Telework available from anywhere in the United States.

Skills

US Citizenship

HIPAA compliance

Regulatory reporting

Analytical thinking

CMS/Medicare regulatory knowledge

Regulatory communications

Education

Bachelor's degree

High School Diploma

Tools

Fraud detection tools

Data mining

ICD-10 CPT HCPCS coding

Job description

Peraton, via its SafeGuard Services (SGS) division, is seeking a Fraud Investigative Subject Matter Expert to lead complex investigations and mentor a team of investigators.

The role focuses on advanced analysis, cross-team collaboration, and testimony readiness, with telework options nationwide in the United States and close coordination with CMS, law enforcement, and government contractors.