Complaints/Referrals Team Lead – Medicare

🔥 14 hours ago

🏈 Alabama, Florida, +5 more states – Remote

🏈 Alabama – Remote 🐊 Florida – Remote 🌲 North Carolina – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote

💵 $66k - $106k / year

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Peraton

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

Peraton is a mission-focused enterprise that supports national security initiatives through advanced IT and cyber services. They provide capabilities in areas such as cyber defense, cloud operations, engineering, and intelligence. With a commitment to solving complex challenges, Peraton integrates data-driven technologies to ensure mission success for their military and government clients.

📋 Description

• Achieve quality objectives and oversee workload to promote timely development and resolution of investigations • Develop cases for referral to law enforcement or other entities • Provide mentoring and guidance to the investigative team • Act as a point of contact for the manager • Assist team members with referral background, analysis, and workflow development • Review individual workload during monthly meetings, assist with prioritization, and conduct quality control for staff • Monitor the quality of UCM/WMM • Monitor timeliness for case updates and prioritize referrals and complaints as leads and investigations as necessary • Monitor complaint and referral progress to ensure use of available remedies, transfer to field investigations, and recommend further review • Mentor team members in identifying previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development

🎯 Requirements

• 8 years with a BS/BA or 12 years of experience with a HS Diploma • At least 5 years of relevant investigative experience required • Strong communication and organization skills • Strong leadership background • Strong PC knowledge and skills • U.S. citizenship required • Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program • Experience in developing leads and investigations, conducting detailed background and link analysis, reviewing claims data, performing medical review, and/or developing fraud cases • 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 and 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 communicate effectively, internally and externally • Ability to mentor and train others • Ability to interpret laws and regulations • Ability to handle confidential material • Ability to report work activity on a timely basis • Ability to work independently and as a member of a team to deliver high quality work • Ability to attend meetings, training, and conferences; overnight travel required • Ability to document QC results in WMM according to record type

🏖️ Benefits

• Telework available from AL, FL, GA, NC, SC, TN, VA, WV • Employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay