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Worker Compensation Fraud Investigator Jobs (NOW HIRING)

State of Georgia

$50/hr

Investigator - Medicaid Fraud Job Requisition ID: JR0000000386 Number of Openings: 1 Shift ... Day (United States of America) Compensation Details: STARTING IN THE $50'S (COMMENSURATE WITH ...

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Worker Compensation Fraud Investigator information

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How much do worker compensation fraud investigator jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for worker compensation 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 is a worker compensation fraud investigator?

A Worker Compensation Fraud Investigator is responsible for identifying and investigating potential fraudulent claims related to workers’ compensation. They review medical records, conduct surveillance, interview witnesses, and collaborate with legal professionals to determine the validity of claims. Their goal is to prevent fraudulent activities that could lead to financial losses for employers and insurance companies. By gathering evidence and reporting their findings, they help ensure that workers' compensation benefits go to those who truly need them.

What are the main daily responsibilities of a worker compensation fraud investigator?

As a Worker Compensation Fraud Investigator, your day-to-day tasks typically include reviewing claim files, gathering evidence through interviews and field surveillance, analyzing medical and employment records, and preparing detailed investigative reports. You may also collaborate closely with insurance adjusters, legal teams, and sometimes law enforcement to validate findings and support potential legal action. While much of the work is independent, teamwork is important for sharing insights and coordinating complex investigations. Maintaining a high degree of confidentiality and professionalism is essential throughout the process. This dynamic combination of investigative work, documentation, and collaboration makes each day in the role both challenging and rewarding.

What are the key skills and qualifications needed to thrive in the worker compensation fraud investigator position, and why are they important?

To thrive as a Worker Compensation Fraud Investigator, you need a background in investigative techniques, detailed knowledge of workers' compensation laws, and experience in fact-finding or law enforcement. Familiarity with case management software, digital databases, surveillance equipment, and sometimes relevant certifications such as Certified Fraud Examiner (CFE) is highly valued. Strong analytical thinking, attention to detail, effective communication, and integrity distinguish top performers in this position. These skills are critical for accurately identifying fraudulent claims, compiling thorough case reports, and collaborating with insurers or legal teams to protect organizational resources.

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Worker Compensation Fraud Investigator jobs near you
Infographic showing various Worker Compensation Fraud Investigator job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, and 4% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $64,132 per year, or $30.8 per hour.

Healthcare Fraud Investigator

Contact Government Services, LLC

San Francisco, CA

$85K - $105K/yr

Full-time

Re-posted 22 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.

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