Fraud Investigator – Federal Court Expert Witness, Medicare, Medicaid

Peraton

. Support prosecution of cases within the SE UPIC .

Posted 11/12/2026full-timeRemote • United StatesSeniorLead💰 $86,000 - $138,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare and Medicaid policies, with a strong background in healthcare investigations and case prosecution. Capable of effectively communicating and collaborating with various stakeholders while mentoring team members in identifying fraud and abuse.

Highest-signal resume keywords

Healthcare Investigative ExperienceMedicare and Medicaid KnowledgeFederal Court Testifying ExperienceStrong Communication SkillsDocumented Law Enforcement Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case DevelopmentClaims ReviewMedical ReviewFraud Case DevelopmentResearch and AnalysisRegulatory InterpretationDocumentation and ReportingOrganizing Case FilesMonitoring Investigation ProgressEscalating Case Updates

Soft Skills

Strong Organizational SkillsEffective CommunicationMentoringTeam CollaborationIndependence

Tools & Technologies

PC KnowledgeWMM Documentation

Certifications & Qualifications

CFE CertificationAHFI Certification

Industry Keywords

MedicareMedicaidHHS OIGState Medicaid AgenciesDepartment of JusticeFraudWasteAbuseFederal/State AgenciesProgram Safeguard Matters

About the role

Key responsibilities & impact

Support prosecution of cases within the SE UPIC
Act as liaison between the SE UPIC, HHS OIG, State Medicaid Agencies (SMA), and the Department of Justice (DOJ)
Understand and develop expertise in Medicare and Medicaid policies to prepare cases for prosecution
Assist investigators with case development
Respond to requests from USAO and DOJ
Travel extensively within the USA
Monitor timeliness of case updates and escalate to management as necessary
Monitor investigation and case progress to ensure use of available remedies, including suspension, pre-pay reviews, and revocation
Mentor team members in identifying previously undetected fraud, waste, or abuse through research, analysis, and development
Conduct training on case development for prosecution, including best practices and lessons learned
Attend regional meetings with HHS OIG, FBI, SMA, and other Federal/State agencies
Coordinate coverage with designated leads when necessary

Requirements

What you’ll need

Minimum of 8 years with BS/BA; minimum of 6 years with MS/MA; minimum of 3 years with PhD
Healthcare investigative experience required
Previous experience testifying in Federal Court in related healthcare prosecutions
Strong communication and organization skills
Strong PC knowledge and skills
Ability to travel within the US as needed
Applicant must be a U.S. citizen
Knowledge of Medicare and Medicaid requirements, laws, rules and regulations related to payment for services billed the Program
Experience in reviewing claims, performing medical reviews, and/or developing fraud cases
Documented experience working in a law enforcement environment specific to the Medicare and Medicaid Programs
Documented experience in preparing and testifying for cases associated with Medicare and Medicaid rules, policies, and program requirements
Ability to perform research and draw conclusions
Ability to present issues of concern, citing regulatory violations, alleging 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 on a timely basis
Ability to work independently and as a member of a team
Ability to attend meetings, training, and conferences; overnight travel required
Document QC results in WMM according to record type
Master’s Degree preferred
CFE or AHFI certification preferred

Benefits

Comp & perks

Medical insurance
Dental insurance
Vision insurance
Life insurance
Health savings account
Short-term disability
Long-term disability
Employee assistance program (EAP)
Parental leave
401(k)
Paid time off (PTO) for vacation
Company paid holidays
Potential overtime
Shift differential
Discretionary bonus