Administrative Action Specialist – Team Lead

Peraton

. Achieve quality objectives and oversee workload to promote timely development and resolution of multiple administrative actions within an investigation .

Posted 9/25/2026full-timeRemote • United StatesSenior💰 $66,000 - $106,000 per yearWebsite

About the role

Key responsibilities & impact

Achieve quality objectives and oversee workload to promote timely development and resolution of multiple administrative actions within an investigation
Mentor and guide the administrative action team
Guide investigation teams on requirements for pursuing an administrative action
Act as a point of contact for the manager
Work with CMS on proceeding with and finalizing administrative actions
Assist team members with workflow and administrative action development
Review workloads during workload meetings, assist with prioritization, and conduct quality control for staff
Monitor the quality of WMM/UCM
Monitor timeliness for case updates and escalate to management as necessary
Monitor administrative action progress to ensure timeframes and metrics are met
Participate in investigation-requested meetings to discuss administrative actions
Participate in CMS high-priority projects and provide direction to the team
Develop efficient workflow processes and evaluate their effectiveness
Research issues and draw conclusions
Present concerns, regulatory violations, and alleged fraud schemes or scams to defraud the Government
Organize case files and document investigative steps
Compose correspondence and reports
Report team work activity on a timely basis
Document QC results in WMM according to record type
Coordinate coverage with other designated leads during absences

Requirements

What you’ll need

Minimum of 8 years with BS/BA or 12 years of experience and a HS Diploma
8 years of relevant investigative experience required
Knowledge of Medicare requirements, laws, rules and regulations related to payment of services billed to the Program
Medicare claims processing knowledge
Strong communication and organization skills
Strong PC knowledge and skills
US citizenship required
Experience in reviewing claims, performing medical reviews, and/or developing fraud cases
CFE or AHFI certification a plus
Ability to perform research and draw conclusions
Ability to present issues of concern, citing regulatory violations and alleging schemes or scams to defraud the Government
Ability to organize a case file and accurately and thoroughly document all steps taken
Ability to compose correspondence and reports
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 for the team
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 may be required
Ability to document QC results in WMM according to record type
Ability to coordinate with other designated leads for coverage during absences

Benefits

Comp & perks

Telework available from East Coast
Employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay
Equal opportunity employment, including disability and protected veterans, or other characteristics protected by law