Fraud Investigator

Peraton

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

Posted 9/24/2026full-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 ExperienceCommunication SkillsOrganizational Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative ReportingData AnalysisMedical ReviewFraud Case DevelopmentClaims ReviewEvidentiary Pattern AnalysisRecord ExaminationInterviewing SkillsRegulatory KnowledgeTechnical Requirements Evaluation

Soft Skills

Strong CommunicationOrganizationAdaptabilityObjectivityConfidentiality

Tools & Technologies

Data SystemsInvestigation ToolsPC Knowledge

Industry Keywords

Healthcare ComplianceFraud InvestigationProgram RegulationsFederal and State LawsHealth Privacy Information

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 as part of teams with state and/or federal investigators
Manage multiple caseload assignments concurrently
Organize and analyze complex evidentiary patterns
Interview witnesses and other individuals and obtain statements
Prepare 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 and recommend appropriate actions
Prepare correspondence and referral summary letters
Maintain objectivity, accuracy, tact, and confidentiality when handling health privacy information
Adapt investigation plans and respond effectively to unplanned situations
Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters
Manage and prioritize workload to meet or exceed customer metrics

Requirements

What you’ll need

2 years with BS/BA; 0 years with MS/MA; 6 years with a HS Diploma/equivalent
Knowledge of Medicare and/or Medicaid programs and related 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
U.S. citizenship required
Preferred: strong background in investigations
Preferred: experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
Preferred: knowledge of investigative practices regarding healthcare providers
Preferred: background evaluating, reviewing, and analyzing medical claims and records
Preferred: ability to learn and operate data systems, equipment, and tools used in investigations
Ability to attend meetings, training, and conferences; overnight travel required
May be required to appear in court and testify about work findings

Benefits

Comp & perks

Telework available from listed U.S. locations
Overtime eligibility may apply
Shift differential may apply
Discretionary bonus may be available