Fraud Investigator

Peraton

. Perform high-level complex investigations of medical professional service providers .

Posted 10/13/2026full-timeRemote • United StatesMid-LevelSenior💰 $51,000 - $82,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong investigative skills and knowledge of Medicare and Medicaid programs, with the ability to analyze complex evidentiary patterns and prepare detailed investigative reports. Capable of managing multiple caseloads while maintaining confidentiality and objectivity in handling sensitive health information.

Highest-signal resume keywords

Investigative SkillsKnowledge of Medicare and MedicaidHealthcare Industry ExperienceStrong Communication SkillsCase File Organization

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative PracticesMedical ReviewClaims ReviewData AnalysisRegulatory InterpretationEvidentiary AnalysisReport PreparationResearch SkillsFraud Case DevelopmentConfidential Material Handling

Soft Skills

Strong Organization SkillsAbility to Work IndependentlyTeam CollaborationTact and ObjectivityEffective Workload Management

Tools & Technologies

Data SystemsInvestigation EquipmentPC Knowledge

Industry Keywords

Healthcare ComplianceProvider EducationOverpayment RecoveryFederal and State LawsWitness InterviewingHealth Privacy InformationBeneficiary AdvocacyAdministrative Actions

About the role

Key responsibilities & impact

Perform high-level complex investigations of medical professional service providers
Develop cases for referral to law enforcement, provider education, overpayment recovery, and other administrative actions
Work with internal resources, external agencies, state investigators, and federal investigators to develop cases and corrective actions
Respond to requests for data and support
Handle multiple caseload assignments concurrently
Organize and analyze complex evidentiary patterns
Interview witnesses and other parties and obtain statements
Prepare complex investigative reports applying regulations, rules, and applicable federal or state laws
Research relevant offenses and investigate alleged violations
Obtain information and evidence through observation, record examination, and interviews
Analyze investigation results to determine whether allegations are corroborated
Determine appropriate steps to address identified issues
Prepare correspondence and referral summary letters
Maintain objectivity, accuracy, tact, and confidentiality when handling health privacy information
Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters
Attend meetings, training, and conferences; travel overnight as required
Appear in court to testify about work findings when required

Requirements

What you’ll need

2 years with BS/BA or 6 years with a HS Diploma/equivalent
Knowledge of Medicare and/or Medicaid programs and their rules, regulations, policies and procedures
Knowledge and experience in the healthcare industry
Strong investigative skills
Strong communication and organization skills
Strong PC knowledge and skills
US citizenship is required
Ability to perform research and draw conclusions
Ability to organize a case file and accurately document all steps taken
Ability to interpret laws and regulations
Ability to handle confidential material
Ability to manage and prioritize workload effectively
Ability to work independently and as a member of a team
Ability to attend meetings, training, conferences, and required overnight travel
Strong background in investigations
Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
Knowledge of investigative practices regarding healthcare providers
Background evaluating, reviewing, and analyzing medical claims and records
Ability to learn and operate data systems, equipment, and tools used in investigations

Benefits

Comp & perks

Telework available from specified states and District of Columbia
Overtime eligibility may be available
Shift differential may be available
Discretionary bonus may be available