Medicaid Fraud Oversight Specialist

Summary

This position is located in the Department of Health and Human Services, Office of Inspector General, Office of Evaluation and Inspections. The announcement will close at 11:59p.m. EST on the date the applicant limit has been reached which may be sooner than the closing date. Resumes must be no more than 2-pages in length.

Duties

• Duties for the Medicaid Fraud Oversight Specialist, GS-0301-12 include but not limited to: Recommends comprehensive solutions to MFCU Oversight Division (MOD) director and other OIG officials that will further the purpose and objective of the MFCU grant program. Analyzes and evaluates recertification applications and other materials to ensure that MFCUs are adhering to published performance standards as well as applicable law and regulations Analyzes sources of information in support of inspections, from evidence, including databases, to establish the accuracy and authenticity of the information. Works to improve effectiveness of the MFCUs by assisting with oversight issues; identifying available resources, such as subjectexperts and data systems; and encouraging collaboration with OIG on fraud cases and other initiatives. Works on MFCU-related special assignments comprised of sensitive and/or confidential information about specific issues pertaining to Medicaid provider fraud and patient abuse or neglect and executes all aspects of the MFCU oversight process in an accurate and timely manner. Conducts periodic onsite reviews of selected MFCUs, in compliance with evaluation standards of the Council for the Inspectors General on Integrity and Efficiency (CIGIE) and prepares written reports of those reviews. Proposes recommended courses ofaction based upon the review, such as corrective action or other grant sanctions. Makes oral presentations on findings andrecommendations. In collaboration with statisticians, information technology, and other experts, collects and analyzes statistical and other pertinent data from various sources and assists with the preparation of the Annual MFCU report. Supports enhanced and targeted evaluation reviews for selected states conducted by regional off ices. Serves as the primary subject matter expert for those reviews and provides logistical and analytical support. Coordinates oversight activities as necessary with the Centers for Medicare & Medicaid Services (CMS), Administration for Community Living (ACL), and other HHS and Federal agencies. Prepares responses to Congressional and other types of correspondence and requests for information regarding MFCU matters. Represents MOD at conferences, training sessions, and meetings to disseminate information, provide technical advice, and present training on the MFCU oversight to various-sized audiences.

Qualifications

You must meet the requirements of the job by 11:59 (Eastern Standard Time) of the closing date: 09/21/2026 Applicants must meet all the qualification requirements, including education, and any selective placement factors described below within 30 days of the closing date of this announcement. Minimum Qualification Requirements: Applicants MUST have 1 year of specialized experience equivalent to the GS-11 grade level in the Federal service which provided the applicant with the particular knowledge, skills and abilities to perform the duties of the position. Qualifying specialized experience demonstrates the following: (1) Experience monitoring or overseeing a federally funded or State administered healthcare program to ensure adherence to applicable laws, regulations, and performance standards (e.g., program statutes, Federal grant requirements, or regulatory criteria); (2) Experience planning, conducting, and evaluating healthcare program reviews or assessments-such as certification/recertification activities-to determine program effectiveness and recommend improvements; (3) Experience collecting, analyzing, and interpreting healthcare program or performance data from multiple sources to identify trends, assess program performance, and support data driven recommendations or reporting; (4) Experience liaising with internal and external stakeholders-such as healthcare program officials, State agencies, oversight bodies, or multidisciplinary teams-to gather information, provide guidance, negotiate solutions, and support collaborative healthcare program oversight; AND (5) Experience preparing clear, concise, and technically accurate written materials (e.g., reports, evaluations, correspondence) that communicate healthcare program findings, compliance issues, or recommendations to management or external partners. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Your resume should include the dates of all qualifying experience (from month/year to month/year) and the number of hours worked/volunteered per week. Federal experience is not required. The experience may have been gained in the public sector, private sector or Volunteer Service. One year of experience refers to full-time work; part-timework is considered on a prorated basis. To ensure full credit for your work experience, please indicate dates of employment by month/year, and indicate number of hours worked per week, on your resume.

How to apply

To begin the process, click the Apply Online button to create an account or log in to your existing USAJOBS account. Follow the prompts to complete the assessment questionnaire. Please ensure you click the Submit My Answers button at the end of the process. Resume must be limited to two-pages to receive consideration. A complete application package for this vacancy must be received on-line via the USA Staffing web site by 11:59 PM (EST) on 09/21/2026 to receive consideration. Mailed/emailed applications will not be accepted. Note: For information on how to edit your application, visit: USA Jobs Help: Updating your submitted application Questions regarding this vacancy or the application process should be directed to the HR Specialist. This announcement may be used to fill one or more vacancies.