Peraton · 22 hours ago
Fraud Investigator
US
Full-time
Hybrid
Entry, Mid Level
$51K/yr - $82K/yr
2+ years expPeraton is a next-generation national security company that drives missions of consequence. They are seeking a Fraud Investigator to perform high-level complex investigations of medical professional service providers, develop cases for future action, and work with internal and external resources to address issues of fraud, waste, and abuse.
Information TechnologyRobotics
No H1B
U.S. Citizen Only
Responsibilities
Perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions
Work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support
Use good judgment and may work independently with minimum supervision and direction
May work as part of a team as there may be times when the investigator needs to work with state and/or federal investigators and other personnel
Handle multiple caseload assignments concurrently; organize and analyze complex evidentiary patterns; interview and obtain statements from witnesses and others
Complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated
Research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations; obtain information and evidence by observation, record examination, and interview
Analyze the results of the investigation to ascertain if the allegations have been corroborated and work with others to determine the appropriate steps that need to be taken to address the issues
Prepare correspondence; be objective and accurate and communicate with others with tact
React to unplanned situations, be flexible in planning their activities and adopt effective courses of action
Maintain confidentiality and understand all the laws, rules and regulations concerning health privacy
Qualification
Required
4 years with AS/AA; 2 years with BS/BA; 6 years with High School diploma
2 years investigative experience
Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies and procedures
Knowledge and experience in the healthcare industry
Strong investigative skills
Strong communication and organization skills
Strong PC knowledge and skills
US citizenship is required
Ability to perform research and draw conclusions
Ability to organize a case file, accurately and thoroughly document all steps taken
Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
Ability to compose correspondence, reports and referral summary letters
Ability to communicate effectively, internally and externally
Ability to interpret laws and regulations
Ability to handle confidential material
Ability to manage and prioritize workload effectively so that customer metrics are met or exceeded
Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters
Ability to work independently and as a member of a team to deliver high quality work
Ability to attend meetings, training, and conferences, overnight travel required
This position may require the incumbent to appear in court to testify about work findings
Preferred
Strong background in investigations
Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
Knowledge of investigative practices regarding healthcare providers
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
Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.
Company
Peraton
Peraton Fearlessly solving the toughest national security challenges.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Thomas Terjesen
Chief Information Officer
Recent News
Washington Technology
2026-01-22
2025-09-25
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