Fraud Investigations Team Lead

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.

As a Fraud Investigator Team Lead, this individual’s primary responsibilities include achieving quality objectives, workload oversight to promote timely development and resolution of investigations and development of cases for referral to law enforcement or other entities and provide mentoring and guidance to investigative team.  The individual exercises significant independent judgment within broadly defined policies and practices to determine the best method for accomplishing work and achieving objectives.    

 What You’ll do:

• There may be multiple of these individuals for a task order, and they may lead significantly different activities
• Act as a point of contact for manager
• Assist team members with workflow development.
• Review individual workload during monthly meetings; assist with prioritizing and conduct QC for staff.
• Monitor the quality of WMM/UCM
• Monitor timeliness for case updates and escalating to management as necessary.
• Monitor the progress of investigations and cases to ensure use of all available remedies, i.e., suspension, pre-pay reviews, revocation, etc.
• Mentor team members so that they can identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.
• Telework available from East Coast

Essential Functions Include:

• Ability to perform research and draw conclusions
• Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
• Ability to organize a case file, accurately and thoroughly document all steps taken
• Ability to compose correspondence, reports and referral summary letters
• Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters
• Ability to interpret laws and regulations

Required Qualifications:

• Minimum of 8 years with BS/BA or 12 years of experience with HS Diploma
• Solid investigative experience required
• Strong communication and organization skills
• Strong PC knowledge and skills
• Able to communicate effectively, internally and externally
• Must be a US Citizen

Preferred Qualifications:

• Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program
• Experience in reviewing claims, performing medical review, and/or developing fraud cases
• CFE or AHFI certification a plus