Technical Project Management, Senior Advisor

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) program 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 Medicaid fraud is actually detected, investigated, and adjudicated in the CMS program-integrity ecosystem.

Key Responsibilities

• Serve as the healthcare program-integrity and FWA subject-matter authority 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 (known-bad-actor sets, adjudicated case outcomes, referral/enforcement outcomes) used to evaluate AI-generated leads and case files.
• Shape analyst-facing use of Peraton[X] (Peraton’s AI tool) and Rapid FI (Fraud Intelligence) so generated leads, dashboards, and case files match real UPIC/MEDIC/MFCU/FDOC investigator workflows.
• Evaluate AI-generated outputs for factual, clinical, and procedural accuracy; represent the analyst voice back to engineering.
• Partner with the Fraud Signals AI Engineer to validate Babel Street correlations against known fraud patterns, and with the Peraton[X] Support SME on user onboarding and training material.

• Minimum of 12 years with BS/BA; Minimum of 10 years with MS/MA; Minimum of 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/hospice/prescription typologies.
• Direct experience inside the CMS program-integrity ecosystem: UPICs, MEDICs, MFCUs, HHS-OIG, DOJ, and Federal/State task-force coordination.
• Demonstrated ability to define and curate ground-truth datasets or investigative reference sets used to evaluate fraud-detection outputs.
• 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 (provider-risk scores, ASRs, model alerts, NCD policy references), enough to interpret them, not to build them.
• Comfort partnering with AI/analytics engineers without needing to write code — the SME provides domain judgment, not implementation.
• Excellent written and verbal communication; comfortable representing findings to CMS stakeholders and law-enforcement partners.
• US citizen with the ability to obtain a Public Trust clearance.

Nice to Have

• Certified Fraud Examiner (CFE) credential
• Prior work with UPICs, MEDICs, CPS, OIG, DOJ, or as a CMS analyst.
• Hands-on experience with SAP BusinessObjects (Web Intelligence) on Medicare/Medicaid universes, plus SAS, Snowflake/Snowsight, or Databricks.
• Exposure to agentic AI / LLM analyst tools and comfort using them to accelerate lead review and case building.
• Familiarity with T-MSIS and cross-state Medicaid data.
• Clinical, coding (CPT/HCPCS/ICD-10), or nursing background.
• Experience authoring analyst training material, job aids, or short training modules.