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Contract Fraud Investigator Jobs (NOW HIRING)

Highmark Health

Investigator

New York, NY · On-site

... contract, etc. * Develop and maintain annual anti-fraud program which includes facilitating fraud training and fraud awareness day, as well as filing annual fraud plans and reports according to state ...

New

Highmark Health

Investigator

Pittsburgh, PA · On-site

... contract, etc. * Develop and maintain annual anti-fraud program which includes facilitating fraud training and fraud awareness day, as well as filing annual fraud plans and reports according to state ...

New

Peraton

Fraud Investigations Team Lead

$66K - $106K/yr

As a Fraud Investigator Team Lead , this individual's primary responsibilities include achieving ... and contract considerations. Depending on the position, employees may be eligible for overtime ...

Serco USA

Sr. Manager Fraud Prevention

Herndon, VA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... contract. The position ensures timely and effective investigation, mitigation and response, and provides management with reports, insights and recommendations based on application of advanced data ...

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Contract Fraud Investigator information

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How much do contract fraud investigator jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for contract fraud investigator in the United States is $30.83, according to ZipRecruiter salary data. Most workers in this role earn between $22.12 and $35.34 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a contract fraud investigator, and why are they important?

To thrive as a Contract Fraud Investigator, you need strong analytical skills, attention to detail, and a background in criminal justice, law, or finance. Familiarity with investigative tools, case management systems, and sometimes certifications such as CFE (Certified Fraud Examiner) are typically required. Excellent communication, critical thinking, and discretion are vital soft skills for effectively interviewing subjects and maintaining confidentiality. These skills are crucial to accurately detecting, investigating, and preventing fraudulent activity while upholding legal and ethical standards.

What does a contract fraud investigator do?

A Contract Fraud Investigator is responsible for identifying, investigating, and preventing fraudulent activities related to contracts and procurement processes. They analyze documentation, conduct interviews, gather evidence, and collaborate with legal and compliance teams to ensure that contract transactions are legitimate and comply with regulations. Their work helps protect organizations from financial losses and reputational damage caused by fraud.

What are some common challenges faced by contract fraud investigators, and how can they be addressed?

Contract Fraud Investigators often encounter challenges such as quickly adapting to ever-evolving fraud schemes, managing large volumes of complex data, and coordinating with multiple stakeholders across departments. Staying current with new investigative techniques and fraud trends is essential, as is leveraging data analytics tools to identify patterns efficiently. Building strong communication skills helps in working collaboratively with legal teams, law enforcement, and other investigators, ensuring thorough and timely case resolution.
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Contract Fraud Investigator jobs near you
Infographic showing various Contract Fraud Investigator job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 18% Part Time, and 1% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $64,132 per year, or $30.8 per hour.

Fraud Investigator-Kansas City, MO area

Blue Cross and Blue Shield of Kansas City

Kansas City, MO • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 14 days ago

Job description

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:
  • Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
  • Annual incentive bonus plan based on company achievement of goals
  • Time away from work including paid holidays, paid time off and volunteer time off
  • Professional development courses, mentorship opportunities, and tuition reimbursement program
  • Paid parental leave and adoption leave with adoption financial assistance
  • Employee discount program

Job Description Summary: As part of Blue KC's Special Investigations Unit (SIU), the Fraud Investigator conducts reviews to identify potential fraud, waste, and abuse (FWA) and claim overpayments. Assigned cases and projects are generally of moderate complexity and performed with limited oversight.Job Description
  • Assist in performing ongoing FWA risk assessments, leveraging data analytics to identify trends, patterns, outliers relative to peers and clinical standards, etc. In conjunction with the Manager and/or Senior Investigator, evaluate FWA risks and prioritize for further review, based upon member health/safety and protection of plan assets.
  • Monitor hotlines, internal referrals, external fraud alerts (e.g., CMS, BCBSA), external healthcare anti-fraud workgroups, and other resources for potential FWA schemes.
  • Conduct investigations of fraud, waste and abuse in accordance with SIU policies and procedures. May work with Manager and/or Senior Investigator on larger, more complex, investigations.
  • Create and maintain detailed case files in accordance with SIU policies and procedures, where key investigative activities and outcomes are timely and accurately documented
  • Prepare detailed case reports summarizing investigative findings and recommendations. Present reports to key stakeholders (e.g., Provider Relations, Medical Management, Pharmacy, Claims, Legal)
  • Assist in coordinating responses to subpoenas and preparation of cases for referral to law enforcement and/or regulators.
  • Perform day-to-day activities for vendor-based claim overpayment recovery program (e.g., data file exchanges, proposing / reviewing new audit concepts, coordinating claim adjustments, invoices).
  • Assist in preparing reports for executive updates, Blue KC Audit Committee, BCBSA/FEP surveys, and other reports as needed.
  • Support the FWA training program for Blue KC employees and First Tier, Downstream and Related entities.

Minimum Qualifications

  • Bachelor's degree in criminal justice, finance, accounting, medical or other relevant academic discipline. 1 years investigative experience in the following areas (e.g., medical review, financial, medical analytics, behavioral health, research & adjustment, appeals) that provided the types and levels of knowledge, skills, and abilities required.
  • Strong communication skills with a broad range of individuals and groups (e.g., members, providers, operational areas, medical directors, provider relations, legal counsel, senior management)

Preferred Qualifications

  • Master's degree in criminal justice, finance, accounting, medical or other relevant academic discipline
  • 3 years' experience conducting healthcare FWA investigations at a health insurer; experience analyzing claims data to identify FWA trends and patterns using tools such as Excel and business intelligence platforms (e.g., Power BI, Business Objects).
  • Knowledge of major BCBSKC business systems (e.g., Facets, ITS Host and Home) and operational processes (e.g., Claims Processing, Pharmacy, Provider Contracting/Relations, Member Services, Customer Service)
  • Knowledge of BCBSKC provider contracts, medical policies and member benefits
  • Knowledge of medical terminology and ICD/CPT coding
  • Experience working with the regulators (e.g., CMS, State Department of Insurance) and law enforcement (e.g., FBI, DEA, HHS-OIG, OPM-OIG and/or Department of Justice)
  • Juris Doctorate
  • Coding Certification: AAPC, AHIMA
  • FWA Certification: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI)
  • Medical License: Registered Nurse (RN), Licensed Practical Nurse (LPN), pharmacist, physician
  • Licensed Clinal Social Worker (LCSW)
  • Licensed Professional Counselor (LPC)

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

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