Fraud Investigator – Medicare

Peraton

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

Posted 11/9/2026full-timeRemote • United StatesMid-LevelSenior💰 $66,000 - $106,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting complex investigations of medical professional service providers, analyzing evidentiary patterns, and preparing detailed investigative reports while ensuring compliance with healthcare regulations. Proficient in collaborating with various stakeholders and educating them on program safeguard matters.

Highest-signal resume keywords

Investigative ExperienceKnowledge Of Medicare ProgramMedical Claims AnalysisStrong Communication SkillsOrganizational Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative PracticesMedical ReviewFraud Case DevelopmentEvidentiary AnalysisReport WritingData Systems OperationClaims Review

Soft Skills

Strong CommunicationOrganization

Tools & Technologies

Data SystemsPC Knowledge

Industry Keywords

Healthcare ProvidersMedicare RegulationsFederal LawsState LawsConfidentiality Compliance

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, external agencies, state and federal investigators, and other personnel
Handle multiple caseload assignments concurrently
Organize and analyze complex evidentiary patterns
Interview witnesses and other individuals and obtain statements
Complete investigative reports applying program regulations, rules, and 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 appropriate corrective actions
Prepare objective and accurate correspondence, reports, and referral summary letters
Maintain confidentiality of health privacy information and comply with applicable laws, rules, and regulations
Conduct site verifications to verify provider operational status
Perform field work on a monthly basis, with approximately 25% travel
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
Report work activity in a timely manner
Attend meetings, training, and conferences

Requirements

What you’ll need

5 years with BS/BA; or 9 years with a HS Diploma/equivalent
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 (desirable)
Knowledge of investigative practices regarding healthcare providers (desirable)
Knowledge of Medicare program and its rules, regulations, policies and procedures (desirable)
Background in 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

Medical, dental, and vision benefits
Life insurance
Health savings account
Short- and 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
Overnight travel required for meetings, training, and conferences