Investigations Team Lead
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Investigations Team Lead overseeing fraud, waste, and abuse investigations for Peraton’s SafeGuard Services. Mentoring investigators, monitoring quality and timeliness, and developing law-enforcement referrals.
Responsibilities:
- 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
Similar Jobs
Team Lead, Property
Part-time remote property claims team lead supervising Sedgwick's insurance claims operations. Managing claims quality, escalations, reserves, licensing, and colleague performance.
Patient Service Team Lead
Patient Service Team Lead scheduling procedures, visits, and ancillary services for AGA gastroenterology patients. Leading service-center staff, monitoring quality, and maintaining HIPAA-compliant patient records.
Docs Team Lead
Docs Team Lead leading technical writers and owning API documentation for Payabli’s embedded payments fintech platform. Building docs tooling, agent resources, and release documentation.
Sustainable Solutions Team Lead
Sustainable Solutions Team Lead leading Eastern US sales specialists for Valent USA’s sustainable crop protection solutions. Driving regional growth through strategy, grower relationships, and technical leadership.
Medical Scribes Team Lead
Medical Scribes Team Lead overseeing healthcare documentation operations at ISTA Solutions, an outsourcing/offshoring company. Managing workflows, quality, coaching, reporting, and live medical scribing.
VidOps Team Lead
VidOps Team Lead leading Beamr’s video solutions engineering team and customer engagements. Designing video processing solutions, managing evaluations, and partnering with Sales on commercial opportunities.
Care Management Clinician – Team Lead
Care Management Clinician Team Lead supervising PacificSource health plan clinical care managers in North Carolina. Improving workflows, service quality, and member care outcomes.
Care Management Clinician Team Lead
Care Management Clinician Team Lead overseeing clinical care teams and health services operations for PacificSource health insurance members. Coaching staff, improving processes, and coordinating member care.
Care Management Clinician – Team Lead
Clinician Team Lead managing PacificSource health plan case management teams and care programs. Supervising staff, improving workflows, and coordinating member services remotely in North Carolina.
Care Management Clinician – Team Lead
Care Management Clinician Team Lead supervising clinical care managers and improving Health Services programs. Supporting PacificSource members’ access to quality, affordable health insurance care.
Team Lead, Messaging & Services
Team Lead strengthening Twilio’s Messaging & Services Support team. Coaching technical support engineers, improving workflows, and resolving complex cloud communications escalations.
Service Desk Team Lead
Service Desk Team Lead overseeing 24/7 IT support, contractor performance, and service reporting for SAIC’s defense and mission technology services.
Fraud Threat Team Lead
Fraud Threat Team Lead guiding analysts through OSINT, WEBINT, and technical fraud investigations. Delivering actionable intelligence and mitigation guidance for Alice’s AI and online safety clients.
Claims Team Lead
Claims Team Lead managing 12–15 examiners and claims operations for HealthEdge’s AI-powered health insurance infrastructure. Driving accuracy, KPIs, service levels, training, and operational excellence.
Team Lead, Contract Care Coordination
Team Lead supervising clinical care coordination for Centerstone’s military behavioral health services. Managing staff, compliance, referrals, audits, and provider outreach.
Team Lead – BPO, German, French
BPO Team Lead supervising German- and French-speaking sales agents for WorkNomads’ global remote talent community. Managing KPIs, schedules, coaching, escalations, and process improvements.
Service Team Lead
Service Team Lead guiding Trellis’s remote insurance call-center team. Coaching agents, improving P&C service quality, and driving retention and cross-sell results.
Data Team Lead
Data Team Lead owning data architecture, lakehouse development, and team leadership. Guiding analytics and decisions for a global health and wellness company.
DAM Team Lead
DAM Team Lead building Fresh Prints' scalable custom-apparel product catalog and QA systems. Leading a three-person team through a 100x ecommerce catalog expansion.
Expert Team Lead, Medicine
Expert Team Lead guiding AI Tutors producing medical training data and evaluations for SpaceXAI’s models. Ensuring domain quality, operational excellence, and team performance.