Fraud Investigator – Medicare

Peraton

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

Posted 9/18/2026full-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 maintaining confidentiality of health privacy information. Proficient in educating stakeholders on program safeguard matters and interpreting relevant laws and regulations.

Highest-signal resume keywords

Investigative ExperienceStrong Communication SkillsOrganizational SkillsKnowledge of Medicare and Medicaid ProgramsAbility to Analyze Medical Claims

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative SkillsResearch SkillsCase File OrganizationReport WritingData AnalysisRegulatory InterpretationMedical ReviewFraud Case DevelopmentEvidentiary AnalysisConfidentiality Maintenance

Soft Skills

Effective CommunicationTeam CollaborationIndependenceTime ManagementProblem Solving

Tools & Technologies

Data SystemsInvestigation Equipment

Industry Keywords

Healthcare InvestigationsProvider EducationOverpayment RecoveryFederal and State LawsProgram Safeguard Matters

About the role

Key responsibilities & impact

Perform high-level complex investigations of medical professional service providers
Develop cases for referral to law enforcement, provider 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 and obtain statements from witnesses and others
Complete complex investigative reports applying regulations, rules, and applicable federal or state laws
Research relevant offenses and conduct investigations to detect or verify suspected violations
Obtain information and evidence through observation, record examination, and interviews
Analyze investigation results to determine whether allegations are corroborated
Determine appropriate steps with others to address identified issues
Prepare objective and accurate correspondence
Maintain confidentiality of health privacy information
Appear in court to testify about work findings when required
Educate providers, provider associations, law enforcement, contractors, and beneficiary advocacy groups on program safeguard matters
Attend meetings, training, and conferences

Requirements

What you’ll need

5 years with a Bachelors or 9 Years with a HS Diploma/equivalent
Investigative experience
Strong investigative skills
Strong communication and organization skills
Strong PC knowledge and skills
U.S. citizenship required
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
Experience reviewing claims for technical requirements, performing medical review, and/or developing fraud cases (desirable)
Knowledge of investigative practices regarding healthcare providers (desirable)
Knowledge of Medicare and/or Medicaid programs and related rules, regulations, policies and procedures (desirable)
Background evaluating, reviewing and analyzing medical claims and records (desirable)
Ability to learn and operate a variety of data systems, equipment and tools used in investigations (desirable)

Benefits

Comp & perks

Telework available from Georgia
Overtime may be available
Shift differential may be available
Discretionary bonus may be available
Overnight travel required