Fraud Investigator – Medicare

Peraton

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

Posted 10/14/2026full-timeRemote • Florida • United StatesMid-LevelSenior💰 $66,000 - $106,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates strong investigative skills with a focus on healthcare provider compliance, including the ability to analyze medical claims and apply relevant regulations. Proficient in communication and organization, capable of educating stakeholders and preparing detailed investigative reports.

Highest-signal resume keywords

Investigative ExperienceKnowledge Of Medicare ProgramMedical Claims ReviewEffective CommunicationData Analysis

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Investigative ReportingEvidentiary AnalysisRegulatory InterpretationFraud Case DevelopmentResearch Skills

Soft Skills

Organizational SkillsInterpersonal SkillsConfidentiality ManagementTeam CollaborationEffective Presentation

Tools & Technologies

Data SystemsPC Knowledge

Industry Keywords

Healthcare ComplianceFraud InvestigationClaims EvaluationFederal RegulationsState Laws

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 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 investigation results to determine whether allegations are corroborated
Determine appropriate steps to address investigative issues with other stakeholders
Prepare objective and accurate correspondence
Maintain confidentiality of health privacy information and comply with applicable laws, rules, and regulations
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 BS/BA or 9 years with a HS Diploma/equivalent
Strong investigative experience
Strong communication and organization skills
Strong PC knowledge and skills
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 the Medicare program and its rules, regulations, policies and procedures
Background in evaluating, reviewing and analyzing medical claims and records
Ability to learn and operate data systems, equipment and tools used in investigations
Ability to perform research and draw conclusions
Ability to present regulatory violations and alleged schemes or scams to defraud the Government
Ability to organize a case file and accurately 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
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

Benefits

Comp & perks

Telework available from Florida
Employees may be eligible for overtime
Employees may be eligible for shift differential
Employees may be eligible for a discretionary bonus
Equal opportunity employer, including disability and protected veterans