Fraud Investigator/Auditor

Peraton

. Manage the full case lifecycle of potential fraud, waste, and abuse matters under Medicaid program integrity .

Posted 9/30/2026full-timeRemote • United StatesMid-LevelSenior💰 $66,000 - $106,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing fraud, waste, and abuse investigations within Medicaid, including analyzing provider data and conducting audits. Proficient in regulatory compliance, documentation, and effective communication with stakeholders.

Highest-signal resume keywords

Fraud InvestigationMedicaid Program KnowledgeClaims AnalysisRegulatory ComplianceStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative PracticesMedical ReviewData AnalysisCase DocumentationBilling Pattern AnalysisEvidence DevelopmentAdministrative RemediesResearch SkillsReport PreparationConfidentiality Management

Soft Skills

Strong Organizational SkillsEffective CommunicationTeam CollaborationIndependent WorkAttention to Detail

Tools & Technologies

Data SystemsTracking SystemsInvestigative Tools

Industry Keywords

MedicaidCMS Program Integrity ManualHealthcare RegulationsFraud PreventionClaims Review

About the role

Key responsibilities & impact

Manage the full case lifecycle of potential fraud, waste, and abuse matters under Medicaid program integrity
Receive, triage, and assess complaints, referrals, and leads
Determine jurisdiction, scope, and preliminary validity of allegations
Analyze provider data, billing patterns, and case documentation
Vet matters for duplicate, prior, or out-of-scope reviews
Coordinate deconfliction with CMS, state Medicaid agencies, managed care organizations, and partner agencies
Document vetting outcomes, case status, contacts, and disposition rationale
Conduct provider audits and investigations, including claims analysis, medical record reviews, and interviews
Identify billing irregularities, documentation gaps, and systemic vulnerabilities
Develop evidence-supported findings for potential administrative, civil, or criminal action
Draft, recommend, and process administrative remedies, including overpayment determinations and referrals
Prepare reports for CMS, state agencies, and law enforcement partners
Support rebuttals, appeals, and settlements related to administrative findings
Maintain comprehensive case documentation in designated tracking systems
Ensure compliance with the CMS Program Integrity Manual, Statement of Work, and state-specific regulations
Contribute to reports, dashboards, and metrics tracking case outcomes, recoveries, and contract performance
Organize and analyze complex evidentiary patterns, interview witnesses, and obtain statements
Research applicable offenses, laws, rules, and regulations
Prepare objective correspondence and investigative reports
Maintain confidentiality of health privacy information

Requirements

What you’ll need

5 years of experience with a BS/BA or 3 years with a Masters Degree
Strong investigative skills
Strong communication and organization skills
Strong PC knowledge and skills
Must be a US Citizen
Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
Knowledge of investigative practices regarding healthcare providers
Knowledge of Medicare and/or Medicaid programs and related rules, regulations, policies, and procedures
Background evaluating, reviewing, and analyzing medical claims and records
Ability to learn and operate a variety of data systems, equipment, and investigative tools
Ability to perform research and draw conclusions
Ability to present regulatory violations and alleged schemes or scams to defraud the Government
Ability to organize case files and accurately document investigative steps
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 report work activity timely
Ability to work independently and as part of a team
Ability to attend meetings, training, and conferences
Ability to appear in court and testify about work findings

Benefits

Comp & perks

Potential eligibility for overtime
Shift differential may be available
Discretionary bonus may be available
Overnight travel required