Fraud Investigator

Peraton

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

Posted 10/9/2026full-timeRemote • United StatesJuniorMid-Level💰 $39,000 - $62,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong investigative and analytical capabilities, with a focus on healthcare compliance audits and fraud detection. Proficient in organizing and documenting case files while maintaining confidentiality and adhering to relevant regulations.

Highest-signal resume keywords

Investigative ExperienceAnalytical SkillsKnowledge of Medicare and MedicaidCommunication SkillsOrganizational Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative PracticesAudit PracticesMedical ReviewFraud Case DevelopmentClaims ReviewRegulatory InterpretationData AnalysisReport WritingDocumentation SkillsResearch Skills

Soft Skills

Effective CommunicationAdaptabilityTeam CollaborationTactful InteractionConfidentiality Management

Tools & Technologies

Data SystemsInvestigation ToolsPC Knowledge

Industry Keywords

Healthcare ComplianceFraud DetectionOverpayment RecoveryLaw Enforcement CollaborationProgram Safeguard Education

Tech Stack

Tools & technologies

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About the role

Key responsibilities & impact

Support high-level investigations of medical professional service providers
Develop cases and reports for law-enforcement referrals, education, overpayment recovery and other administrative actions
Support fraud investigators and auditors in developing cases, audits and corrective 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 information supporting the team’s workload
Assist with complex reports applying regulations or rules to affected programs
Research and understand relevant offenses
Conduct efficient and effective investigations and audits concerning alleged offenses
Detect or verify suspected violations through observation, record examination and interviews
Analyze investigation and audit results to determine whether allegations are corroborated
Help determine appropriate steps to address identified issues
Prepare objective, accurate correspondence and communicate tactfully
React to unplanned situations and adapt investigative activities and courses of action
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 preferred among competitive candidates
Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases and identifying overpayments preferred among competitive candidates
Knowledge of investigative or audit practices regarding healthcare providers preferred among competitive candidates
Knowledge of Medicare and/or Medicaid programs and their rules, regulations, policies and procedures preferred among competitive candidates
Background evaluating, reviewing and analyzing medical claims and records preferred among competitive candidates
Ability to learn and operate a variety of data systems, equipment and tools used in investigations
Ability to perform research and draw conclusions
Ability to document information supporting 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 and thoroughly document all steps taken
Ability to compose correspondence, reports and referral summary letters
Ability to educate providers, provider associations, law enforcement, other 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 to deliver high-quality work
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, or other characteristics protected by law