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 with the ability to analyze complex evidentiary patterns and interpret laws and regulations. Proficient in managing caseloads, conducting interviews, and preparing detailed investigative reports while maintaining confidentiality and objectivity.

Highest-signal resume keywords

Investigative SkillsCommunication SkillsOrganizational SkillsKnowledge of Medicare and Medicaid ProgramsAbility to Testify in Court

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative ReportingResearch and AnalysisCase File OrganizationMedical ReviewFraud Case DevelopmentRegulatory InterpretationData System OperationEvidentiary AnalysisClaims ReviewConfidential Material Handling

Soft Skills

AdaptabilityTactObjectivityTeam CollaborationMentoring

Industry Keywords

Healthcare InvestigationsFraud SchemesProgram Safeguard MattersOverpayment RecoveryLaw Enforcement Referral

Tech Stack

Tools & technologies

React

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
Manage multiple concurrent caseload assignments
Organize and analyze complex evidentiary patterns
Interview witnesses and other involved parties and obtain statements
Complete investigative reports applying relevant program regulations, rules, and laws
Research relevant offenses and investigate alleged offenses to detect or verify suspected violations
Obtain information and evidence through observation, record examination, and interviews
Analyze investigation results and determine whether allegations are corroborated
Determine appropriate corrective actions with stakeholders
Prepare correspondence and referral summary letters
Maintain objectivity, accuracy, tact, and confidentiality when handling health privacy information
React to unplanned situations and adapt investigative plans
Provide training and mentoring on investigative tools and skills
Develop expertise in tools supporting investigations and identify potential fraud schemes
Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters
Attend meetings, training, and conferences; travel overnight as required
Potentially testify in court regarding investigative findings

Requirements

What you’ll need

5 years with BS/BA or 9 years investigative experience with a HS diploma/equivalent
Three to five years 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 compose correspondence, reports and referral summary letters
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 overnight travel
May be required to appear in court to testify
Experience in 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 in evaluating, reviewing and analyzing medical claims and records (desired)
Ability to learn and operate a variety of data systems, equipment and tools used in investigations (desired)

Benefits

Comp & perks

Potential eligibility for overtime
Potential eligibility for shift differential
Potential eligibility for a discretionary bonus
Telework arrangement
Training and mentoring opportunities