Fraud Investigator – Medicare

Peraton

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

Posted 10/5/2026full-timeRemote • South Carolina • 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 adhering to federal and state laws. Proficient in preparing detailed reports and effectively communicating findings to various stakeholders.

Highest-signal resume keywords

Investigative ExperienceKnowledge Of Medicare ProgramStrong Communication SkillsAbility To Analyze Medical ClaimsAbility To Educate Stakeholders

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative SkillsMedical ReviewClaims ReviewData AnalysisRegulatory InterpretationReport WritingEvidence CollectionCase File OrganizationResearch SkillsFraud Detection

Soft Skills

Strong Organizational SkillsEffective CommunicationAbility To Work IndependentlyTeam CollaborationConfidentiality Maintenance

Tools & Technologies

Data SystemsInvestigation ToolsPC Knowledge

Industry Keywords

Healthcare InvestigationsFraud CasesRegulatory ViolationsProgram Safeguard MattersWitness Interviews

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 and obtain statements from witnesses and others
Complete complex investigative reports applying regulations or rules to affected programs
Apply federal or state laws as needed
Research and understand relevant offenses
Conduct investigations concerning alleged offenses and detect or verify suspected violations
Obtain information and evidence through observation, record examination, and interview
Analyze investigation results to determine whether allegations are corroborated
Determine appropriate steps with others to address identified issues
Prepare correspondence and communicate objectively, accurately, and tactfully
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

Requirements

What you’ll need

5 years with BS/BA; or 9 years with a HS Diploma
Investigative experience
Strong investigative skills
Strong communication and organization skills
Strong PC knowledge and skills
US 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 the 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 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, 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
Overnight travel required

Benefits

Comp & perks

Telework available from Atlanta, GA area or South Carolina
Employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay
Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law