Investigations Team Lead

Job not on LinkedIn

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $66k - $106k / year

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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 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 escalate to management as necessary • Monitor investigation and case progress to ensure use of all available remedies, including suspension, pre-pay reviews, and revocation • Mentor team members in identifying previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development • Coordinate with other designated leads for coverage when necessary

🎯 Requirements

• Minimum of 8 years with BS/BA or 12 years with a HS Diploma/equivalent • Relevant investigative experience required • CFE or AHFI certification preferred • Strong communication and organization skills • Strong PC knowledge and skills • US. citizenship required • 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 • 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 communicate effectively, internally and externally • 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 • Ability to coordinate with other designated leads for coverage during periods where the lead is out of the office during work hours

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Life insurance • Health savings account • Short-term disability • Long-term disability • Employee assistance program (EAP) • Parental leave • 401(k) • Paid time off (PTO) for vacation • Company paid holidays • Eligible employees may be eligible for overtime • Shift differential • Discretionary bonus

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