Fraud Referral Specialist – Medicare

Peraton

. Use a variety of tools to evaluate referrals and complaints and develop investigations to identify potential fraud .

Posted 10/14/2026full-timeRemote • Florida • United StatesJuniorMid-Level💰 $51,000 - $82,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong analytical and investigative skills to evaluate referrals and complaints, conduct research, and report findings related to potential fraud. Proficient in data analysis, documentation, and communication with various stakeholders, including law enforcement and provider associations.

Highest-signal resume keywords

Investigative ExperienceData AnalysisRegulatory InterpretationExcel ProficiencyStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisResearchReport WritingBackground InvestigationsFraud DetectionCase DocumentationInterviewingRegulatory ComplianceClaims AnalysisConfidential Material Handling

Soft Skills

Interpersonal SkillsOrganizational SkillsTime ManagementSelf-MotivationTeam Collaboration

Tools & Technologies

ExcelPC Knowledge

Industry Keywords

Medicare ProgramFraud InvestigationProvider EducationGovernment ComplianceBeneficiary Advocacy

About the role

Key responsibilities & impact

Use a variety of tools to evaluate referrals and complaints and develop investigations to identify potential fraud
Respond to referrals from other entities
Field requests for data and support
Analyze and interpret claims data for aberrancies
Conduct interviews
Report findings and take quick, appropriate follow-up actions
Refer cases to field investigative teams or the data team for further analysis
Perform research and draw conclusions
Present concerns, citing regulatory violations and alleging schemes or scams to defraud the Government
Organize case files and accurately document all steps taken
Conduct background investigations on providers within the Medicare program
Compose correspondence, reports, and referral summary letters
Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters
Potentially appear in court to testify about work findings

Requirements

What you’ll need

2 years with BS/BA or 6 years with a HS diploma/equivalent
Strong interpersonal, analytical, research, and organizational skills
Excellent verbal and written communications
Strong PC knowledge and skills
Strong use of Excel and ability to sort and filter data
Strong time management and organizational skills
Self-driven and motivated
U.S. citizenship required
1 or 2 years of investigative or analytical experience preferred
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, with some overnight travel required

Benefits

Comp & perks

Telework available from Florida
Overtime may be available
Shift differential may be available
Discretionary bonus may be available
Some overnight travel required for meetings, training, and conferences