Admin Actions Fraud Manager - Medicare

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.

We are looking to add an Admin Actions Fraud Manager to our SGS team of talented professionals

What you'll do:

This Admin Actions Fraud Manager position entails providing direction to a staff of Admin Action Specialists to identify and research issues of potential fraud, waste and abuse.  Primary responsibilities include oversight and assistance to the development of cases for referral to law enforcement or other entities and responding to requests for data and support for existing casework.   

• Establish goals, objectives and plans for the unit
• Motivate staff and evaluate performance
• Plan resources to address workload needs, set priorities and report unit activity
• Develop, administer, and control a budget
• Administer compensation and other corporate polices
• Recruit and develop staff.
• Telework available from Central/Eastern Time Zones (Alabama, Florida, Georgia, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia preferred)

Basic Qualifications:

• 10 years of experience, may have supervisory or lead experience
• This position requires proven leadership skills and in-depth knowledge of the Medicare Program as it pertains to reviewing claims and provider behavior for indications of potential fraud, waste and abuse.
• Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program.
• Excellent organizational and communications skills as well as strong PC skills.
• Ability to effectively work independently and as a member of a team
• U.S. citizenship required