Fraud Investigator

Peraton

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

Posted 10/14/2026full-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. Effectively communicates findings and educates stakeholders while maintaining confidentiality and compliance with relevant regulations.

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 TechniquesRegulatory ComplianceResearch Skills

Soft Skills

Strong CommunicationOrganizationTeam CollaborationIndependenceTactfulness

Tools & Technologies

Data SystemsPC Knowledge

Industry Keywords

Healthcare RegulationsFraud InvestigationConfidentialityOverpayment RecoveryLaw Enforcement Collaboration

About the role

Key responsibilities & impact

Perform high-level complex investigations of medical professional service providers
Develop cases for law-enforcement referral, education, overpayment recovery, and other administrative actions
Work with internal resources, external agencies, state and federal investigators, and other personnel
Respond to requests for data and support
Handle multiple caseload assignments concurrently
Organize and analyze complex evidentiary patterns
Interview witnesses and other individuals and obtain statements
Complete investigative reports applying relevant program regulations, rules, and laws
Research relevant offenses and conduct efficient 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 objective, accurate correspondence and communicate tactfully
Maintain confidentiality of health privacy information and comply with applicable laws, rules, and regulations
Perform research and draw conclusions
Organize case files and document investigative steps accurately and thoroughly
Present concerns, regulatory violations, and alleged schemes or scams to defraud the Government
Compose correspondence, reports, and referral summary letters
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
Work independently and as part of a team
Attend meetings, training, and conferences; complete required overnight travel
Appear in court to testify about work findings when required

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 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
U.S. citizenship required
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, conferences, and overnight travel
May be required to appear in court to testify about work findings

Benefits

Comp & perks

Telework available from specified U.S. locations
Overtime may be available
Shift differential may be available
Discretionary bonus may be available
Equal opportunity employer, including disability and protected veterans