Fraud Investigator – Medicare

Peraton

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

Posted 11/3/2026full-timeRemote • Florida • United StatesSeniorLead💰 $66,000 - $106,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive investigative experience in healthcare fraud detection, including knowledge of Medicare regulations and the ability to analyze complex medical claims. Proficient in communication and organization, with a strong capacity to work independently and collaboratively with various stakeholders.

Highest-signal resume keywords

Investigative ExperienceKnowledge Of Medicare RegulationsCommunication SkillsOrganizational SkillsAbility To Analyze Medical Claims

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative ReportingData AnalysisMedical ReviewFraud Case DevelopmentEvidentiary Pattern AnalysisInterviewing TechniquesRegulatory ComplianceClaims ReviewField WorkCourt Testimony

Soft Skills

Strong CommunicationStrong OrganizationTeam CollaborationIndependenceConfidentiality Maintenance

Tools & Technologies

Data SystemsInvestigation EquipmentRecord Examination Tools

Industry Keywords

Healthcare FraudMedicare ProgramFederal RegulationsState LawsProvider Site Verification

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 individuals and obtain statements
Complete complex investigative reports applying 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 investigation results and determine whether allegations are corroborated
Prepare correspondence and referral summary letters
Conduct provider site verifications, including monthly field work as needed
Maintain confidentiality of health privacy information
Present issues of concern and cite regulatory violations or alleged schemes to defraud the Government
Organize case files and document investigative steps accurately and thoroughly
Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters
Report work activity timely and communicate effectively internally and externally
Work independently and as part of a team with state and federal investigators
Travel approximately 25%, including overnight travel

Requirements

What you’ll need

5 years with BS/BA; or 9 years with a HS Diploma/equivalent
Solid investigative experience
Strong communication and organization skills
Strong PC knowledge and skills
Must be able to rent a car and have a valid driver's license
U.S. citizenship required
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 program and its 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
Ability to appear in court to testify about work findings
Ability to attend meetings, training, and conferences; overnight travel required

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
Overtime eligibility
Shift differential eligibility
Discretionary bonus eligibility
Telework available from Florida and Georgia