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How much do healthcare fraud investigator jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for healthcare 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 some common challenges faced by healthcare fraud investigators, and how can they be addressed?

Healthcare Fraud Investigators frequently encounter challenges such as interpreting complex billing codes, navigating large volumes of data, and staying current with ever-changing healthcare regulations. Collaboration with legal teams, auditors, and healthcare providers is essential to accurately identify fraudulent activities without disrupting legitimate operations. Ongoing training and leveraging advanced data analytics tools can help investigators manage these challenges and improve the accuracy and efficiency of their investigations.

What does a healthcare fraud investigator do?

As a healthcare fraud investigator, you investigate possible healthcare fraud committed by a health care provider who is trying to bill for an unperformed or unnecessary service. Your duties include researching evidence and documents, interviewing the provider and patient, gathering information to review, analyzing claims, and producing reports with your final recommendations. You must conduct investigations with an unbiased view and communicate with an adjustment claim representative, law enforcement, attorneys, and the organization. A healthcare fraud investigator may handle multiple cases at once and may testify at legal proceedings if necessary. Most of these positions are with insurance companies.

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

To thrive as a Healthcare Fraud Investigator, you need strong analytical skills, attention to detail, and a background in healthcare, law enforcement, or criminal justice, often supported by a relevant degree or certification. Familiarity with claims processing systems, data analysis tools, and knowledge of healthcare regulations such as HIPAA are typically required. Excellent communication, critical thinking, and integrity are vital soft skills for conducting thorough investigations and interviewing stakeholders. These skills and qualities are essential for detecting fraudulent activity, ensuring compliance, and protecting organizational and patient interests.

Is fraud investigation a good career?

A healthcare fraud investigator plays a key role in detecting and preventing fraudulent activities in healthcare systems, often requiring analytical skills and knowledge of regulations. The profession offers job stability, competitive salaries, and opportunities for advancement, especially with relevant certifications and experience. It can be a rewarding career for those interested in law enforcement, compliance, and healthcare industries.
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Healthcare Fraud Investigator jobs near you
Infographic showing various Healthcare Fraud Investigator job openings in the United States as of August 2026, with employment types broken down into 3% As Needed, 67% Full Time, 15% Part Time, and 15% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $64,132 per year, or $30.8 per hour.

Healthcare Fraud Investigator

Contact Government Services, LLC

Chantilly, VA

$85K - $105K/yr

Full-time

Re-posted 18 days ago

Job description

Healthcare Fraud Investigator
Employment Type: Full-Time, Mid-Level
Department: Litigation Support

CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. 

CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities.

Responsibilities will Include:
- Review, sort, and analyze data using computer software programs such as Microsoft Excel.
- Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.).
- Develop HCF case referrals including, but not limited to:
- Ensure that HCF referrals meet agency and USAO standards for litigation.
- Analyze data for evidence of fraud, waste and abuse.
- Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence.
- Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings.
- Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc.
- Assist conducting witness interviews and preparing written summaries.

Qualifications:
- Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field.
- Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.
- Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc.
- Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data).
- Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy.
- U.S. Citizenship and ability to obtain adjudication for the requisite background investigation.
- Experience and expertise in performing the requisite services in Section 3.
- Must be a US Citizen.
- Must be able to obtain a favorably adjudicated Public Trust Clearance.
Preferred qualifications:
- Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3.
- Relevant experience working with a federal or state legal or law enforcement entity.

#CJ

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.