Fraud Referral Specialist – Medicare

Peraton

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

Posted 11/11/2026full-timeRemote • United StatesJuniorMid-Level💰 $39,000 - $62,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong analytical and investigative capabilities, with proficiency in data analysis, report writing, and effective communication. Familiarity with regulatory compliance and the ability to handle confidential information are essential.

Highest-signal resume keywords

Investigative ExperienceData AnalysisRegulatory ComplianceReport WritingInterpersonal Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisResearch SkillsExcel ProficiencyInvestigative TechniquesReport Writing

Soft Skills

Interpersonal SkillsOrganizational SkillsTime ManagementSelf-MotivationEffective Communication

Tools & Technologies

PC KnowledgeExcel

Industry Keywords

Fraud InvestigationMedicare ProgramRegulatory ViolationsConfidential MaterialBackground Investigations

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 issues of concern, 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

Requirements

What you’ll need

0 years with BS/BA; 4 years with a high school diploma/equivalent
Strong interpersonal, analytical, research, and organizational skills
Excellent verbal and written communication
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
May be required to appear in court to testify about work findings
Ability to communicate effectively internally and externally
Ability to interpret laws and regulations
Ability to handle confidential material
Ability to report work activity in a timely manner
Ability to work independently and as a member of a team
Ability to attend meetings, training, and conferences
Some overnight travel required

Benefits

Comp & perks

Medical insurance
Dental insurance
Vision insurance
Life insurance
Health savings account
Short-term disability
Long-term disability
Employee assistance program (EAP)
Parental leave
401(k)
Paid time off (PTO) for vacation
Company-paid holidays
Potential eligibility for overtime
Potential eligibility for shift differential
Potential eligibility for a discretionary bonus