Fraud Investigator – Medicare

Peraton

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

Posted 11/10/2026full-timeRemote • United StatesMid-LevelSenior💰 $66,000 - $106,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive investigative experience with a strong ability to analyze complex evidentiary patterns and prepare detailed reports. Proficient in interpreting laws and regulations related to healthcare, while maintaining confidentiality and compliance with applicable standards.

Highest-signal resume keywords

Investigative ExperienceStrong Communication SkillsAbility to Analyze EvidenceKnowledge of Medicare RegulationsAbility to Work Independently

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case DevelopmentResearch SkillsReport WritingData AnalysisField WorkInterviewing SkillsEvidentiary AnalysisRegulatory InterpretationDocumentation SkillsClaims Review

Soft Skills

Organizational SkillsEffective CommunicationTeam CollaborationConfidentiality ManagementProblem-Solving

Tools & Technologies

Data SystemsInvestigation ToolsPC Knowledge

Industry Keywords

Healthcare InvestigationsFraud DetectionMedicare Program ComplianceProvider EducationOverpayment Recovery

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
Work independently with minimal supervision and direction
Collaborate with state and/or 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 complex investigative reports applying applicable program regulations and 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 and appropriate corrective steps
Prepare objective and accurate correspondence
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
Attend meetings, training, and conferences, including overnight travel

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
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; overnight travel required
Desirable: Strong background in investigations
Desirable: 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 program 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

Benefits

Comp & perks

Medical, dental, and vision insurance
Life insurance
Health savings account
Short-term and long-term disability
Employee assistance program (EAP)
Parental leave
401(k)
Paid time off (PTO) for vacation
Company-paid holidays
Overtime eligibility
Shift differential eligibility
Discretionary bonus eligibility
Telework available from Florida, South Carolina, or Virginia