Fraud Investigator – Medicare

Peraton

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

Posted 9/24/2026full-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 expertise in conducting complex investigations of healthcare providers, analyzing medical claims, and applying relevant regulations. Strong communication and organizational skills are essential for managing multiple caseloads and collaborating with various stakeholders.

Highest-signal resume keywords

Investigative ExperienceKnowledge Of Medicare ProgramStrong Investigative SkillsMedical Review ExperienceData 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 PracticesClaims ReviewEvidentiary AnalysisReport WritingData Systems Operation

Soft Skills

Strong Communication SkillsOrganizational Skills

Tools & Technologies

Data SystemsPC Knowledge

Industry Keywords

Healthcare ProvidersFraud CasesRegulationsHealth Privacy InformationSite Verifications

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 others and obtain statements
Complete complex investigative reports applying applicable regulations, rules, and laws
Research relevant offenses and conduct investigations to detect or verify suspected violations
Obtain information and evidence through observation, record examination, and interview
Analyze investigation results and determine appropriate corrective steps
Prepare correspondence and referral summary letters
Maintain confidentiality of health privacy information
Conduct site verifications to verify provider operational status
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; 3 years with MS/MA; 0 years with PhD
Investigative experience
Strong investigative skills
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 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

Benefits

Comp & perks

Telework available from South Florida
Overnight travel required
Employees may be eligible for overtime
Employees may be eligible for shift differential
Employees may be eligible for a discretionary bonus