Medicaid Fraud Oversight Specialist

Office of Inspector General; Concord (CA); On-site; USD 70,000 - 100,000; Full time

Job summary

Office of Inspector General in the Department of Health and Human Services seeks a qualified candidate to support evaluation and inspection efforts of healthcare programs. The role requires assessing program performance, compiling findings, and delivering clear written recommendations to management and partners.

Applicants must demonstrate experience with federal healthcare program oversight, data-driven reporting, and effective stakeholder communication.

Qualifications

• Experience monitoring or overseeing a federally funded or State administered healthcare program to ensure adherence to laws, regulations, and performance standards.
• Experience planning, conducting, and evaluating healthcare program reviews or assessments to determine program effectiveness and improvements.
• Experience collecting, analyzing, and interpreting healthcare program data from multiple sources to identify trends and support data-driven reporting.
• Experience liaising with internal and external stakeholders to gather information, guide, negotiate, and support oversight.
• Experience preparing clear, concise, and technically accurate written materials communicating findings, issues, or recommendations.

Skills

Healthcare program oversight

Program reviews/evaluations

Data analysis

Stakeholder liaison

Written communications

Job description

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.

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.