Fraud Investigator – Medicare

Peraton

. Perform high-level, complex investigations of medical professional service providers .

Posted 10/5/2026full-timeRemote • United StatesMid-LevelSenior💰 $66,000 - $106,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong investigative skills and the ability to analyze complex evidentiary patterns while ensuring compliance with healthcare regulations. Proficient in managing caseloads, conducting interviews, and preparing detailed investigative reports.

Highest-signal resume keywords

Investigative ExperienceKnowledge Of Medicare And Medicaid ProgramsAbility To Interpret Laws And RegulationsStrong Communication SkillsAbility To Organize Case Files

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative SkillsResearch SkillsMedical ReviewFraud Case DevelopmentData AnalysisReport WritingEvidentiary AnalysisClaims ReviewRegulatory ComplianceConfidentiality Management

Soft Skills

Organization SkillsCommunication SkillsTeam CollaborationIndependenceMentoring

Tools & Technologies

Data SystemsInvestigative ToolsRecord Examination Equipment

Industry Keywords

Healthcare InvestigationsFraud SchemesProgram RegulationsFederal And State LawsProvider Education

About the role

Key responsibilities & impact

Perform high-level, complex investigations of medical professional service providers
Develop cases for referral to law enforcement, education, overpayment recovery and other administrative actions
Work with internal resources and external agencies to develop cases and corrective actions
Respond to requests for data and support
Handle multiple caseload assignments concurrently
Organize and analyze complex evidentiary patterns
Interview witnesses and other parties and obtain statements
Complete complex investigative reports applying program regulations, rules, and applicable federal or state laws
Research relevant offenses and conduct efficient investigations to detect or verify suspected violations
Obtain information and evidence through observation, record examination, and interviews
Analyze investigative results to determine whether allegations are corroborated and recommend appropriate actions
Prepare objective and accurate correspondence
Maintain confidentiality of health privacy information and comply with applicable laws, rules and regulations
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
Appear in court to testify about investigative findings when required

Requirements

What you’ll need

5 years with BS/BA or 9 years with a HS Diploma/equivalent
5 to 6 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 and thoroughly 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 so that customer metrics are met or exceeded
Ability to work independently and as a member of a team
Ability to attend meetings, training, conferences, and overnight travel
Experience in 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 in evaluating, reviewing and analyzing medical claims and records
Ability to learn and operate a variety of data systems, equipment and tools used in investigations

Benefits

Comp & perks

Overtime eligibility may be available depending on the position
Shift differential may be available depending on the position
Discretionary bonus may be available depending on the position
Overnight travel opportunities/requirements