Fraud Investigator

Peraton

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

Posted 10/14/2026full-timeRemote • United StatesMid-Level💰 $39,000 - $62,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates strong investigative and analytical capabilities, with a solid understanding of healthcare regulations and compliance audits. Proficient in organizing and documenting case files, conducting thorough investigations, and effectively communicating findings to various stakeholders.

Highest-signal resume keywords

Investigative ExperienceAnalytical SkillsKnowledge of Medicare and MedicaidCompliance AuditsStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative PracticesMedical ReviewFraud Case DevelopmentClaims ReviewData Analysis

Soft Skills

Organization SkillsEffective CommunicationTeam Collaboration

Tools & Technologies

Data SystemsRecord Examination Tools

Industry Keywords

Healthcare ComplianceRegulatory ViolationsConfidentiality of Health InformationOverpayment RecoveryFraud Detection

About the role

Key responsibilities & impact

Support high-level complex investigations of medical professional service providers
Develop cases and reports for law-enforcement referral, education, overpayment recovery and other administrative actions
Support fraud investigators and auditors and collaborate with internal resources and external agencies
Respond to data and support requests
Handle multiple caseload assignments concurrently
Organize and analyze information supporting the team’s workload
Assist with complex reports applying regulations or rules to affected programs
Research and understand relevant alleged offenses
Conduct efficient and effective investigations and audits; detect or verify suspected violations
Obtain information and evidence through observation, record examination and interview
Analyze investigation and audit results to determine whether allegations are corroborated
Help determine appropriate corrective actions
Prepare objective and accurate correspondence
Maintain confidentiality of health privacy information and comply with applicable laws, rules and regulations

Requirements

What you’ll need

0 years’ experience with BS/BA, or 4 years’ experience with a HS diploma/equivalent
Investigative and analytical experience
Strong communication and organization skills
Strong PC knowledge and skills
US citizenship required
Strong background in investigations or compliance audits (most competitive candidates)
Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments (most competitive candidates)
Knowledge of investigative or audit practices regarding healthcare providers (most competitive candidates)
Knowledge of Medicare and/or Medicaid programs and related rules, regulations, policies and procedures (most competitive candidates)
Background evaluating, reviewing and analyzing medical claims and records (most competitive candidates)
Ability to learn and operate a variety of data systems, equipment and tools used in investigations (most competitive candidates)
Ability to perform research and draw conclusions
Ability to document investigative/audit workload, present concerns, cite regulatory violations, and allege schemes or scams to defraud the Government
Ability to organize a case file and accurately document all steps taken
Ability to compose correspondence, reports and referral summary letters
Ability to educate providers, provider associations, law enforcement, contractors and beneficiary advocacy groups on program safeguard matters
Ability to communicate effectively internally and externally
Ability to interpret laws and regulations
Ability to handle confidential material
Ability to report work activity in a timely manner
Ability to work under direct supervision as a team member
Ability to attend meetings and training conferences; overnight travel may be required

Benefits

Comp & perks

Telework available from Eastern Time Zone
Overtime may be available
Shift differential may be available
Discretionary bonus may be available
Equal opportunity employer, including disability and protected veterans