Remote Fraud Investigator – Healthcare Claims & Analytics

Peraton; Northern (KY); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Peraton's SafeGuard Services (SGS) invites you to join our team as a Fraud Investigator. You will conduct high‑level investigations of medical providers and develop cases for actions including referrals to law enforcement, education, overpayment recovery and other administrative steps.

You will work with internal resources and external agencies to build cases, respond to data requests, and prepare clear, objective correspondence and reports.

Qualifications

• 5 years with BS/BA or 9 years with HS Diploma/equivalent
• 5–6 years investigative experience
• Strong investigative skills
• Strong communication and organization skills
• Strong PC knowledge and skills
• US Citizenship is required

Responsibilities

• The role involves high level complex investigations of medical professional service providers and developing cases for future action, including referral to law enforcement, education, over payment recovery and other administrative actions.
• Will work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support.
• Investigators research and understand relevant offenses, conduct efficient investigations, obtain information and evidence by observation, record examination, and interview.
• Prepare correspondence and reports, communicate with others with tact, and apply regulations or laws as needed.
• Maintain confidentiality and understand health privacy laws and regulations.

Skills

Investigative skills

Communication skills

Organization skills

PC knowledge

US Citizenship required

Education

BS/BA or HS Diploma with equivalent experience

Job description

Peraton's SafeGuard Services (SGS) invites you to join our team as a Fraud Investigator. You will conduct high‑level investigations of medical providers and develop cases for actions including referrals to law enforcement, education, overpayment recovery and other administrative steps.

You will work with internal resources and external agencies to build cases, respond to data requests, and prepare clear, objective correspondence and reports.