Note: The job is a remote job and is open to candidates in USA. SafeGuard Services (SGS), a subsidiary of Peraton, is hiring a Complaints/Referrals Team Lead to oversee Medicare complaints and referrals. The role guides investigative staff, monitors workload and quality, and supports timely investigation development and referrals involving potential fraud, waste, and abuse.

Responsibilities

• Act as a point of contact for manager
• Assist team members with referral background, analysis, and workflow development
• Review individual workload during monthly meetings; assist with prioritization and conduct QC 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 the progress of complaints and referrals to ensure use of all available remedies, transfer to field investigations, and make recommendations for further review
• Mentor team members so that they can identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development
• 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 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
• Document QC results in WMM according to record type

Skills

• 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
• 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 mentor and train others
• Ability to interpret laws and regulations
• Ability to handle confidential material
• Ability to work independently and as a member of a team to deliver high quality work
• 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

Benefits

• Remote work allowed 100%; telework available from AL, FL, GA, NC, SC, TN, VA, WV
• Employees may be eligible for overtime
• Employees may be eligible for shift differential
• Employees may be eligible for a discretionary bonus in addition to base pay

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