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Medical Fraud Investigator Jobs (NOW HIRING)

Banner Bank

Fraud Investigator

Lake Oswego, OR · On-site

As a Fraud Investigator, you'll play an important role in protecting our customers and our ... Comprehensive employee benefits, including: medical, dental, vision, LTD, STD and life * Paid ...

MUFG Bank, Ltd.

Fraud Investigator

Tampa, FL · Hybrid

$65K - $80K/yr

The Investigator will complete fraud investigations to ensure that potentially suspicious ... medical condition, sexual orientation, genetic information, or any other status of an individual or ...

TikTok

Fraud Investigator

San Jose, CA · On-site

$121K - $220K/yr

Responsibilities - Conduct investigations of policy violation, data leakage, fraud and financial ... Employees have day one access to medical, dental, and vision insurance, a 401(k) savings plan with ...

Suncoast Credit Union

Fraud Investigator II

Tampa, FL · Remote

$60K - $80K/yr

Investigate cases of fraud including check fraud, new account fraud, debit and credit card fraud ... Wellness: Medical Coverage, Dental and Vision Coverage, Access to 4,000+ Gyms, Mental Health ...

SCCU

Fraud Investigator I

Miramar, FL · On-site

$28.13 - $29.79/hr

As a Fraud Investigator I, you will help protect the credit union and its members by investigating ... Medical, dental, and vision insurance, plus an Employee Assistance Program. * Financial Perks ...

SCCU

Fraud Investigator I

Melbourne, FL · Hybrid

$28.13 - $29.79/hr

As a Fraud Investigator I, you will help protect the credit union and its members by investigating ... Medical, dental, and vision insurance, plus an Employee Assistance Program. * Financial Perks ...

SCCU

Fraud Investigator I

Melbourne, FL · On-site

$28.13 - $29.79/hr

As a Fraud Investigator I, you will help protect the credit union and its members by investigating ... Medical, dental, and vision insurance, plus an Employee Assistance Program. * Financial Perks ...

SCCU

Fraud Investigator I

Miramar, FL · Hybrid

$28.13 - $29.79/hr

As a Fraud Investigator I, you will help protect the credit union and its members by investigating ... Medical, dental, and vision insurance, plus an Employee Assistance Program. * Financial Perks ...

Georgia

Investigator - Medicaid Fraud

Atlanta, GA

$50/hr

Investigator - Medicaid Fraud Job Requisition ID: JR0000000386 Number of Openings: 1 Shift: Day ... Assists in developing databases to analyze appropriate medical data. Enters data into databases and ...

Zurich Insurance Group

Claims Fraud Investigator

UT · Remote

Zurich is seeking an experienced Claims Fraud Investigator to join its Claims Fraud and ... medical major case work. The investigator will perform field activities, coordinate vendor ...

Mass General Brigham

SIU Fraud Investigator

Somerville, MA · On-site

$79K - $115K/yr

We believe that high-performing teams drive groundbreaking medical discoveries and invite all ... Essential Functions -Responsible for conducting confidential investigations of suspected fraud ...

Zurich Insurance Group

Claims Fraud Investigator

CA · Remote

Zurich is seeking an experienced Claims Fraud Investigator to join its Claims Fraud and ... medical major case work. The investigator will perform field activities, coordinate vendor ...

Zurich Insurance Group

Claims Fraud Investigator

NV · Remote

Zurich is seeking an experienced Claims Fraud Investigator to join its Claims Fraud and ... medical major case work. The investigator will perform field activities, coordinate vendor ...

Zurich Insurance Group

Claims Fraud Investigator

AZ · Remote

Zurich is seeking an experienced Claims Fraud Investigator to join its Claims Fraud and ... medical major case work. The investigator will perform field activities, coordinate vendor ...

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Medical Fraud Investigator information

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How much do medical fraud investigator jobs pay per hour?

As of Jul 27, 2026, the average hourly pay for medical 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.

Can you get paid for reporting Medicare fraud?

Medical Fraud Investigators who report Medicare fraud may be eligible for whistleblower rewards through the False Claims Act, which can include monetary compensation. These rewards are typically awarded after successful legal action and recovery of funds. The process often involves submitting tips through government channels and may require legal or investigative expertise.

What does a Medical Fraud Investigator do?

A Medical Fraud Investigator is responsible for detecting, investigating, and preventing fraudulent activities related to healthcare claims, billing, and insurance. They analyze medical records, billing data, and other documentation to identify suspicious patterns or inconsistencies. Their work helps protect healthcare programs and insurance companies from financial losses and ensures that resources are used appropriately. Investigators may also collaborate with law enforcement or legal teams if fraudulent activities are confirmed.

What are the key skills and qualifications needed to thrive as a Medical Fraud Investigator, and why are they important?

To thrive as a Medical Fraud Investigator, you need a solid background in healthcare regulations, investigative techniques, and data analysis, often supported by a degree in criminal justice, healthcare administration, or a related field. Familiarity with claims management systems, data mining tools, and certifications such as Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) is highly beneficial. Strong attention to detail, analytical thinking, and effective communication are crucial soft skills for uncovering fraudulent activities and presenting findings. These skills and qualifications are essential to accurately detect, investigate, and prevent fraud, safeguarding healthcare resources and ensuring compliance.

How does a Medical Fraud Investigator typically collaborate with healthcare providers and insurance companies during an investigation?

Medical Fraud Investigators regularly work with healthcare providers and insurance companies to gather evidence, clarify billing practices, and verify the legitimacy of claims. This collaboration often involves conducting interviews, reviewing medical records, and coordinating with compliance or legal teams. Building strong professional relationships is essential, as these stakeholders can provide critical information and insights. Effective communication and diplomacy are key, as investigators must balance thoroughness with sensitivity to ongoing provider relationships.

What qualifications do I need to be a fraud investigator?

Medical fraud investigators typically need a bachelor's degree in healthcare administration, criminal justice, or a related field. Relevant experience in healthcare, insurance, or law enforcement, along with strong analytical skills and knowledge of medical billing and coding, are important. Certifications such as the Certified Fraud Examiner (CFE) can enhance job prospects.

What does a healthcare fraud investigator do?

A healthcare fraud investigator examines medical billing records, claims, and patient data to detect and prevent fraudulent activities such as false claims, billing scams, and identity theft. They often work with law enforcement agencies, use specialized software, and require knowledge of healthcare regulations and compliance standards.

How to become a healthcare fraud investigator?

To become a healthcare fraud investigator, candidates typically need a background in healthcare, law enforcement, or auditing, along with knowledge of healthcare laws and billing practices. Relevant skills include attention to detail, analytical thinking, and familiarity with investigative tools; certifications such as Certified Fraud Examiner (CFE) can enhance prospects. A bachelor's degree in criminal justice, healthcare administration, or a related field is often required, and some roles may require prior law enforcement or auditing experience.
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Medical Fraud Investigator jobs near you
Infographic showing various Medical Fraud Investigator job openings in the United States as of July 2026, with employment types broken down into 2% As Needed, 79% 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

Fraud Investigator

AMOCO Federal Credit Union

Texas City, TX

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 17 days ago

Job description

The Fraud Investigator assists AMOCO in achieving its mission of "serving the financial needs of our members" by investigating and documenting potential fraud and suspicious activities across various types of transactions. The position requires collaboration with cross-functional teams to improve operational efficiency, ensure compliance, and minimize fraud risks. The ideal candidate will have a strong background in fraud investigation and recovery, and will work independently with minimal supervision to present findings and recommendations to management.

Our Culture
 
AMOCO Federal Credit Union is 85+ years strong and recognized as one of the largest credit unions in the Houston/Galveston area. Our culture is driven by staff who exemplify the cooperative spirit of people helping people. By listening and understanding the needs of our membership, we aim to become their trusted financial institution. The goal of every interaction is to create member loyalty and to serve and satisfy the financial needs of our members and employees at every touchpoint in the member service chain. To achieve that, we focus on hiring talent and the right fit for our culture. 
 
Work Perks
 
We offer the following exceptional benefits:
  • Health benefits including medical, dental, and vision for employees
  • Tuition reimbursement
  • 401(k) match
  • Annual Bonus Incentive
  • Paid Company Annual Holidays
  • Paid time off
  • Frequent employee appreciation and recognition events
 
Essential Functions and Duties
 
  • Investigate a variety of fraud-related activities, including ID theft, check fraud, and account takeover cases.
  • Respond to inquiries through different communication channels, providing clear explanations of actions taken in response to alerts or cases.
  • Communicate with both internal and external members regarding fraud concerns, security issues, problem resolution, and investigations.
  • Review and assess data to confirm or disprove fraud claims or charge-offs, escalating as necessary.
  • Prepare detailed reports documenting investigation actions, findings, and results.
  • Maintain and organize data for analysis and future reference.
  • Identify emerging fraud trends and red flags, and provide recommendations for preventive measures to business units and management.
  • Collaborate with other departments to understand transactions, processes, and procedures, and identify potential fraud risks.
  • Recognize and assess fraud activity, recommending actions such as account freezes or member alerts to mitigate exposure.
  • Evaluate operational efficiency and suggest improvements to enhance fraud detection and prevention processes.

Experience

Three years to five years of similar or related experience, including preparatory experience.

Interpersonal Skills

A significant level of trust, credibility and diplomacy is required. In-depth dialogue, conversations and explanationswith customers, direct and indirect reports and outside vendors can be of a sensitive and/or highly confidentialnature. Communications may involve motivating, influencing, educating and/or advising others on matters ofsignificance. Typically includes subject matter experts as well as first level to middle managers.

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