Senior Technical Project Manager

Peraton

. Serve as the healthcare program-integrity and fraud, waste, and abuse subject-matter authority on the AI tool assessment project within the Fraud Prevention System .

Posted 9/29/2026full-timeUnited StatesSenior💰 $176,000 - $282,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise in healthcare program integrity and fraud analytics, with a strong focus on evaluating AI-generated outputs and curating ground-truth datasets. Proficient in translating investigator workflows into actionable use cases for analytics teams while effectively communicating findings to stakeholders.

Highest-signal resume keywords

Healthcare Fraud, Waste, And Abuse (FWA) ExpertiseMedicare And Medicaid Claims Data AnalysisGround-Truth Dataset CurationCMS Program-Integrity Ecosystem KnowledgeCertified Fraud Examiner (CFE)

ATS Keywords

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Hard Skills

Fraud DetectionData AnalysisDataset CurationAI Output EvaluationClinical Coding (CPT/HCPCS/ICD-10)

Soft Skills

Excellent CommunicationCollaboration With Engineers

Tools & Technologies

SAP BusinessObjectsSASSnowflakeDatabricksPeraton[X]

Certifications & Qualifications

Certified Fraud Examiner (CFE)

Industry Keywords

CMSUPICsMEDICsMFCUsHHS-OIGDOJFraud AnalyticsDMEHome HealthMedicaid Data

Tech Stack

Tools & technologies

Babel

About the role

Key responsibilities & impact

Serve as the healthcare program-integrity and fraud, waste, and abuse subject-matter authority on the AI tool assessment project within the Fraud Prevention System
Drive fraud, waste, and abuse use-case selection for the proof of concept, prioritized by fraud impact and analyst value
Define and curate ground-truth datasets, including known-bad-actor sets, adjudicated case outcomes, and referral/enforcement outcomes
Shape analyst-facing use of Peraton[X] and Rapid FI so generated leads, dashboards, and case files match investigator workflows
Evaluate AI-generated outputs for factual, clinical, and procedural accuracy
Represent the analyst voice back to engineering
Partner with the Fraud Signals AI Engineer to validate Babel Street correlations against known fraud patterns
Partner with the Peraton[X] Support SME on user onboarding and training material

Requirements

What you’ll need

Minimum of 12 years with BS/BA; Minimum of 10 years with MS/MA; Minimum of 7 years with Ph.D.
5+ years working with Medicare and/or Medicaid claims data in a program-integrity, audit, investigative, or fraud-analytics role
Deep knowledge of healthcare FWA patterns, including billing schemes, coding manipulation, identity/beneficiary fraud, provider collusion, and DME/home-health/hospice/prescription typologies
Direct experience inside the CMS program-integrity ecosystem, including UPICs, MEDICs, MFCUs, HHS-OIG, DOJ, and Federal/State task-force coordination
Demonstrated ability to define and curate ground-truth datasets or investigative reference sets used to evaluate fraud-detection outputs
Ability to translate investigator and analyst workflows into use cases and acceptance criteria for analytics or AI teams
Familiarity with FPS, IDR, One PI, UCM, or comparable CMS PI systems and their outputs
Comfort partnering with AI/analytics engineers without needing to write code
Excellent written and verbal communication; comfortable representing findings to CMS stakeholders and law-enforcement partners
US citizenship and ability to obtain a Public Trust clearance
Certified Fraud Examiner (CFE) credential is a nice-to-have
Prior work with UPICs, MEDICs, CPS, OIG, DOJ, or as a CMS analyst is a nice-to-have
Hands-on experience with SAP BusinessObjects (Web Intelligence), SAS, Snowflake/Snowsight, or Databricks is a nice-to-have
Exposure to agentic AI/LLM analyst tools is a nice-to-have
Familiarity with T-MSIS and cross-state Medicaid data is a nice-to-have
Clinical, coding (CPT/HCPCS/ICD-10), or nursing background is a nice-to-have
Experience authoring analyst training material, job aids, or short training modules is a nice-to-have

Benefits

Comp & perks

Potential eligibility for overtime
Potential eligibility for shift differential
Potential eligibility for a discretionary bonus