Remote Medicaid Fraud Investigator

Peraton; Northern (KY); Hybrid; USD 66,000 - 106,000; Full time

Job summary

Peraton is seeking an Auditor/Investigator to manage full case lifecycles of potential fraud, waste, and abuse in Medicaid program integrity, from intake through administrative actions. The role requires balancing regulatory knowledge, analytical rigor, and interagency collaboration while protecting taxpayer dollars.

This remote position requires residing within NE jurisdiction states listed; strong investigative, documentation, and reporting skills are essential, with the ability to work

Qualifications

• 5 years experience with BS/BA or 3 years with a Masters.
• Strong investigative, communication, and organizational abilities.
• Knowledge of CMS, Medicaid, and healthcare program integrity.

Responsibilities

• Receive complaints and triage matters to determine jurisdiction and scope.
• Perform provider data analysis and case documentation vetting.
• Conduct audits and investigations of claims and medical records.
• Draft and process administrative remedies and referrals.
• Maintain case activity and ensure regulatory compliance.
• Prepare defensible reports for CMS and law enforcement.
• Communicate findings clearly and maintain confidentiality.

Skills

Strong investigative skills

Strong communication skills

Strong organizational skills

US Citizenship

PC knowledge

Education

BS/BA or MS

Job description

Peraton is seeking an Auditor/Investigator to manage full case lifecycles of potential fraud, waste, and abuse in Medicaid program integrity, from intake through administrative actions. The role requires balancing regulatory knowledge, analytical rigor, and interagency collaboration while protecting taxpayer dollars.

This remote position requires residing within NE jurisdiction states listed; strong investigative, documentation, and reporting skills are essential, with the ability to work