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.
- 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 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. EEOEEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.Skills Required
- Bachelor’s degree with at least 12 years of experience, master’s degree with at least 10 years, or Ph.D. with at least 7 years
- At least 5 years working with Medicare and/or Medicaid claims data in program integrity, audit, investigative, or fraud analytics roles
- Deep knowledge of healthcare fraud, waste, and abuse patterns, including billing schemes, coding manipulation, identity fraud, provider collusion, and DME, home-health, hospice, and prescription typologies
- Direct experience with the CMS program-integrity ecosystem, including UPICs, MEDICs, MFCUs, HHS-OIG, DOJ, and federal or state task-force coordination
- Experience defining and curating ground-truth datasets or investigative reference sets for evaluating 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 program-integrity systems and outputs
- Ability to partner with AI and analytics engineers without writing code, providing domain judgment instead
- Excellent written and verbal communication skills, including presenting findings to CMS stakeholders and law-enforcement partners
- U.S. citizenship and ability to obtain a Public Trust clearance
- Certified Fraud Examiner credential
- Prior work with UPICs, MEDICs, CPS, OIG, DOJ, or as a CMS analyst
- Hands-on SAP BusinessObjects Web Intelligence experience with Medicare or Medicaid data, plus SAS, Snowflake/Snowsight, or Databricks
- Exposure to agentic AI or LLM analyst tools
- Familiarity with T-MSIS and cross-state Medicaid data
- Clinical, coding, or nursing background
- Experience authoring analyst training materials, job aids, or short training modules
Peraton Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Peraton and has not been reviewed or approved by Peraton.
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Healthcare Strength — Healthcare offerings are described as broad, including medical, dental, vision, mental health support, and specialty programs like virtual physical therapy and surgical/cancer care navigation. Medical coverage is also characterized as a standout part of the overall package in terms of perceived quality.
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Retirement Support — Retirement support includes a 401(k) with employer matching and is repeatedly positioned as a strong component of total rewards. The 401(k) benefit is frequently singled out as one of the most valued parts of the package.
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Leave & Time Off Breadth — Time-off benefits are positioned as robust, including PTO, holidays, paid sick days, and floating holidays, with some roles offering notably generous accrual. Leave breadth is reinforced by related programs such as short/long-term disability and bereavement leave.
Peraton Insights
What We Do
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.
Why Work With Us
We are fearlessly solving the world’s most complex challenges to keep people safe and secure. You can be a part of protecting and promoting that freedom around the world.
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