Complaints/Referrals Team Lead - Medicare

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 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 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 c