Data Fraud Manager - Peraton
Home, PA
About the Job
Responsibilities
SafeGuard 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 for a Data Fraud Manager to add to our team of professionals.
What you'll do:
The Data Fraud Manager position entails providing direction to a staff of data analysis unit to identify and research issues of potential fraud, waste and abuse. Primary responsibilities include oversight and assistance to the development of cases for referral to law enforcement or other entities and responding to requests for data and support for existing casework.
- Establish goals, objectives and plans for the unit
- Motivate staff and evaluate performance
- Plan resources to address workload needs, set priorities and report unit activity
- Develop, administer, and control a budget
- Administer compensation and other corporate polices
- Recruit and develop staff
- Provide guidance to staff on how to perform data analysis and take actions necessary to resolve and/or prevent potential fraud or abuse in the insurance/healthcare space.
- Telework available from Any US time zone but Hawaii
Qualifications
Basic Qualifications:
- 10 years of experience, may have supervisory or lead experience
- This position requires proven leadership skills and in-depth knowledge of the Medicare Program as it pertains to reviewing claims and provider behavior for indications of potential fraud, waste and abuse.
- Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program.
- Excellent organizational and communications skills as well as strong PC skills.
- Ability to effectively work independently and as a member of a team
- Has knowledge of claims/reimbursement practices and regulations, regulatory environments, and with investigation processes, tools and practices, case development, and prosecution procedures
- Skilled in data interpretation, fraud examination, fraud research, interviewing skills, analysis, and reporting.
- US Citizenship is required
Peraton Overview
Peraton 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.
