技术项目经理，高级顾问
Technical Project Management, Senior Advisor
职责
Peraton 正在寻找一名技术项目经理，担任欺诈分析专家，作为代理 AI 概念验证团队的医疗保障项目完整性领域专家，支持 CMS 的欺诈预防系统计划（FPS2），推动欺诈/浪费/滥用用例选择、真实数据集整理以及分析师使用推广。与 AI 工程师和调查人员合作，该专家确保 AI 生成的线索、仪表盘和案件文件反映 Medicare 和 Medicaid 欺诈在 CMS 项目完整性生态系统中的实际检测、调查和裁决方式。
主要职责
- 在 FPS 的 AI 工具评估项目中担任医疗保障项目完整性和 FWA 领域专家。
- 推动 POC 的 FWA 用例选择，按欺诈影响和分析师价值优先排序。
- 定义并整理真实数据集（已知恶意行为者集合、已裁决的案件结果、转介/执法结果），用于评估 AI 生成的线索和案件文件。
- 设计 Peraton[X]（Peraton 的 AI 工具）和 Rapid FI（欺诈情报）的分析师使用方式，使生成的线索、仪表盘和案件文件符合 UPIC/MEDIC/MFCU/FDOC 调查员的实际工作流程。
- 评估 AI 生成的输出在事实、临床和程序上的准确性；将分析师的声音反馈给工程团队。
- 与欺诈信号 AI 工程师合作，验证 Babel Street 关联是否符合已知欺诈模式，并与 Peraton[X] 支持专家合作，进行用户上线和培训材料的准备。
资格要求
- 最低 12 年经验，本科或学士学位；最低 10 年经验，硕士或硕士学位；最低 7 年经验，博士学位。
- 5 年以上在项目完整性、审计、调查或欺诈分析岗位中处理 Medicare 和/或 Medicaid 报销数据的经验。
- 对医疗保障欺诈/浪费/滥用模式有深入了解：计费方案、编码操纵、身份/受益人欺诈、供应商共谋、DME/居家护理/临终关怀/处方类型。
- 直接经验在 CMS 项目完整性生态系统中：UPICs、MEDICs、MFCUs、HHS-OIG、DOJ 和联邦/州任务小组协调。
- 有定义和整理真实数据集或调查参考集的经验，用于评估欺诈检测输出。
- 能够将调查员和分析师的工作流程转化为分析或 AI 团队的用例和验收标准。
- 熟悉 FPS、IDR、One PI、UCM 或类似 CMS PI 系统及其输出（提供）
查看英文原文
Responsibilities
Peraton is seeking a Technical Project Manager to fulfill the role of a Fraud Analytics SME to serve as the healthcare program-integrity subject-matter authority on an agentic AI proof-of-concept team supporting the Fraud Prevention System Program (FPS2) program for CMS, driving fraud/waste/abuse use-case selection, ground-truth curation, and analyst-facing adoption. Working alongside AI engineers and investigators, the SME ensures AI-generated leads, dashboards, and case files reflect how Medicare and Medicaid fraud is actually detected, investigated, and adjudicated in the CMS program-integrity ecosystem.
Key Responsibilities
- Serve as the healthcare program-integrity and FWA subject-matter authority on the AI tool assessment project within FPS.
- Drive FWA use-case selection for the POC, prioritized by fraud impact and analyst value.
- Define and curate ground-truth datasets (known-bad-actor sets, adjudicated case outcomes, referral/enforcement outcomes) used to evaluate AI-generated leads and case files.
- Shape analyst-facing use of Peraton[X] (Peraton’s AI tool) and Rapid FI (Fraud Intelligence) so generated leads, dashboards, and case files match real UPIC/MEDIC/MFCU/FDOC 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, and with the Peraton[X] Support SME on user onboarding and training material.
Qualifications
- 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: billing schemes, coding manipulation, identity/beneficiary fraud, provider collusion, DME/home-health/hospice/prescription typologies.
- Direct experience inside the CMS program-integrity ecosystem: 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 (provider-risk scores, ASRs, model alerts, NCD policy references), enough to interpret them, not to build them.
- Comfort partnering with AI/analytics engineers without needing to write code — the SME provides domain judgment, not implementation.
- Excellent written and verbal communication; comfortable representing findings to CMS stakeholders and law-enforcement partners.
- US citizen with the ability to obtain a Public Trust clearance.
Nice to Have
- Certified Fraud Examiner (CFE) credential
- Prior work with UPICs, MEDICs, CPS, OIG, DOJ, or as a CMS analyst.
- Hands-on experience with SAP BusinessObjects (Web Intelligence) on Medicare/Medicaid universes, plus SAS, Snowflake/Snowsight, or Databricks.
- Exposure to agentic AI / LLM analyst tools and comfort using them to accelerate lead review and case building.
- Familiarity with T-MSIS and cross-state Medicaid data.
- Clinical, coding (CPT/HCPCS/ICD-10), or nursing background.
- Experience authoring analyst training material, job aids, or short training modules.
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.
Target Salary Range
$176,000 - $282,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.EEO
EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.Originally posted on Himalayas