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Medical Fraud Investigator Jobs (NOW HIRING)

Koalafi

Fraud Investigator

Richmond, VA · On-site

$61K - $74K/yr

As a Fraud Investigator, you will monitor and research risk signals for both customers and ... Comprehensive medical, dental, and vision coverage * 20 PTO days + 11 paid holidays * 401(k) ...

Koalafi

Fraud Investigator

Richmond, VA · On-site

$61K - $74K/yr

As a Fraud Investigator, you will monitor and research risk signals for both customers and ... Comprehensive medical, dental, and vision coverage * 20 PTO days + 11 paid holidays * 401(k) ...

Koalafi

Fraud Investigator

Arlington, VA · On-site

$61K - $74K/yr

As a Fraud Investigator, you will monitor and research risk signals for both customers and ... Comprehensive medical, dental, and vision coverage * 20 PTO days + 11 paid holidays * 401(k) ...

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 ...

Peraton

Fraud Investigator

$66K - $106K/yr

... fraud, waste, and abuse. What you'll do ... The position is expected to perform high level complex investigations of medical professional ...

TikTok

Fraud Investigator

San Jose, CA · On-site

$121K - $208K/yr

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

Son

Provider Fraud Investigator

Lincoln, NE · On-site

$25.61/hr

JR2026-00028695 Provider Fraud Investigator (Evergreen) (Open) Applications No Longer Accepted On ... Previous experience working with medical claims payment and adjudication, performing financial ...

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 ...

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Medical Fraud Investigator information

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How much do medical fraud investigator jobs pay per hour?

As of Sep 9, 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.

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.

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 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 do you become a medical fraud investigator?

To become a medical fraud investigator, typically one needs a background in healthcare, criminal justice, or a related field, along with experience in medical billing, coding, or auditing. Many employers prefer candidates with certifications such as the Certified Fraud Examiner (CFE) or healthcare-specific credentials, and strong analytical skills are essential for identifying fraudulent activities.

What qualifications do I need to be a Medical 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 also important. Certifications such as Certified Fraud Examiner (CFE) can enhance job prospects.
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Medical Fraud Investigator jobs near you
Infographic showing various Medical Fraud Investigator job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $64,132 per year, or $30.8 per hour.

Fraud Investigator

Texas City, TX • On-site

AMOCO Federal Credit Union
Finance and Insurance • 201 - 500 employees
Learn more about AMOCO Federal Credit Unionexternal

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted yesterday

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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