Fraud Investigator

Peraton

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

Posted 9/24/2026full-timeRemote • United StatesMid-LevelSenior💰 $66,000 - $106,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong investigative skills and the ability to analyze complex evidentiary patterns while maintaining confidentiality and compliance with applicable laws. Proficient in preparing detailed reports and effectively communicating findings to various stakeholders.

Highest-signal resume keywords

Investigative ExperienceRegulatory InterpretationCase File OrganizationCommunication SkillsHealthcare Compliance Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative SkillsResearch SkillsReport WritingData AnalysisMedical ReviewFraud DetectionClaims ReviewEvidentiary AnalysisRegulatory KnowledgeConfidentiality Management

Soft Skills

Strong CommunicationOrganizational SkillsIndependenceTeam CollaborationAdaptability

Tools & Technologies

Investigative ToolsData SystemsPC Knowledge

Industry Keywords

MedicareMedicaidHealthcare ProvidersFraud SchemesAdministrative ActionsLaw Enforcement CollaborationConfidential Health Information

Tech Stack

Tools & technologies

React

About the role

Key responsibilities & impact

Perform high-level, complex investigations of medical professional service providers
Develop cases for referral to law enforcement, education, overpayment recovery and other administrative actions
Work with internal resources and external agencies to develop cases and corrective actions
Respond to requests for data and support
Work independently with minimal supervision and direction
Work with state and federal investigators and other personnel
Handle multiple caseload assignments concurrently
Organize and analyze complex evidentiary patterns
Interview witnesses and other individuals and obtain statements
Complete complex investigative reports applying program regulations, rules and applicable federal or state laws
Research relevant offenses and conduct investigations to detect or verify suspected 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 communicate objectively, accurately and tactfully
React to unplanned situations and adapt investigative plans
Maintain confidentiality of health privacy information and comply with applicable laws, rules and regulations
Provide training and mentoring on investigative tools and skills
Develop expertise in tools supporting investigations and identify potential fraud schemes
Attend meetings, training and conferences; travel overnight as required
Potentially appear in court to testify about investigative findings

Requirements

What you’ll need

5 years of experience with a BS/BA or 9 years of experience with a high school diploma/equivalent
5 to 6 years of investigative experience
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 present issues of concern and cite regulatory violations
Ability to compose correspondence, reports and referral summary letters
Ability to communicate effectively internally and externally
Ability to interpret laws and regulations
Ability to handle confidential material
Ability to manage and prioritize workload effectively
Ability to educate providers, provider associations, law enforcement, contractors and beneficiary advocacy groups
Ability to work independently and as a member of a team
Ability to attend meetings, training and conferences
Ability to travel overnight
May be required to appear in court and testify to work findings
Desired: Experience reviewing claims for technical requirements, performing medical review and/or developing fraud cases
Desired: Knowledge of investigative practices regarding healthcare providers
Desired: Knowledge of Medicare and/or Medicaid programs and related rules, regulations, policies and procedures
Desired: Background evaluating, reviewing and analyzing medical claims and records
Desired: Ability to learn and operate data systems, equipment and tools used in investigations

Benefits

Comp & perks

Overtime eligibility may apply
Shift differential may apply
Discretionary bonus may be available
Telework arrangement
Training and mentoring opportunities
Overnight travel opportunities