Complaints/Referrals Team Lead - Medicare

Complaints/Referrals Team Lead - MedicareJob LocationsUSResponsibilitiesSafeGuard 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 a Complaints/Referrals Team Lead to our SGS team of talented professionals.What You'll do:As an Investigative 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, specifically in the analysis and review of referrals and complaints that are received.Act as a point of contact for managerAssist team members with referral background, analysis, and workflow developmentReview individual workload during monthly meetings; assist with prioritization and conduct QC for staffMonitor the quality of UCM/WMMMonitor timeliness for case updates and prioritize referrals and complaints as leads and investigations as necessaryMonitor the progress of complaints and referrals to ensure use of all available remedies, transfer to field investigations, and make recommendations for further reviewMentor team members so that they can identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.Telework available from AL, FL, GA, NC, SC, TN, VA, WVQualificationsBasic Qualifications:8 years with a BS/BA or 12 years of experience with a HS DiplomaAt least 5 years of relevant investigative experience required.Strong communication and organization skillsStrong leadership backgroundStrong PC knowledge and skillsU.S. citizenship requiredDesirable QualificationsThe most competitive candidates will have:Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the ProgramExperience in developing leads and investigations, conducting detailed background and link analysis, reviewing claims data, performing medical review, and/or developing fraud casesEssential FunctionsAbility to perform research and draw conclusionsAbility to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the GovernmentAbility to organize a case file, accurately and thoroughly document all steps takenAbility to compose correspondence, reports and referral summary lettersAbility to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard mattersAbility to communicate effectively, internally and externallyAbility to mentor and train othersAbility to interpret laws and regulationsAbility to handle confidential materialAbility to report work activity on a timely basisAbility to work independently and as a member of a team to deliver high quality workAbility to attend meetings, training, and conferences, overnight travel requiredDocument QC results in WMM according to record typePeraton OverviewPeraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can't be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we're keeping people around the world safe and secure.Target Salary Range$66,000 - $106,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.EEOEEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.J-18808-Ljbffr Peraton