Senior Healthcare Fraud Analytics PM Advisor

Peraton

Northern (KY)

Hybrid

USD 176,000 - 282,000

Full time

8 days ago

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Job summary

Peraton is seeking a Technical Project Manager to fulfill the role of a Fraud Analytics SME to serve as the healthcare program-integrity subject-matter authority on an agentic AI proof-of-concept team supporting the Fraud Prevention System Program (FPS2) for CMS, driving fraud/waste/abuse use-case selection, ground-truth curation, and analyst-facing adoption.

Working alongside AI engineers and investigators, the SME ensures AI-generated leads, dashboards, and case files reflect how Medicare and

Qualifications

12+ years with 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, DME/home-health/prescription typologies.
Direct CMS program-integrity ecosystem experience: UPICs, MEDICs, MFCUs, HHS-OIG, DOJ, and Federal/State task-force coordination.

Responsibilities

Serve as the 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 used to evaluate AI-generated leads and case files.
Shape analyst-facing use of Peraton[X] and Rapid FI so generated leads, dashboards, and case files match investigator workflows.
Evaluate AI-generated outputs for factual, clinical, and procedural accuracy; represent the analyst voice to engineering.
Partner with the Fraud Signals AI Engineer to validate correlations and with the Peraton[X] Support SME on onboarding and training material.