Medicaid Fraud Oversight Specialist

About the role

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.

What you will do

• 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.

How you will be evaluated

You will be evaluated based on how well you meet the qualifications listed in this vacancy announcement. Your qualifications will be evaluated based on your application materials (e.g., resume, supporting documents), your responses on the application questionnaire, and your responses to all assessments required for this position.

You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics): Compliance Data Management Planning and Evaluating Stakeholder Management Writing Overstating your qualifications and/or experience in your application materials or application questionnaire may result in your removal from consideration.

Cheating on an assessment may also result in your removal from consideration.

Please note that a complete application is required for consideration.

(Please review the "Required Documents" section of this job announcement to see what must be included in a complete application).

To view the application form, visit: *** Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement.

By applying, you agree to have your application shared with interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar across HHS.

Documents you must provide

• All applicants are required to submit the following supporting document type(s): Resume (Two page limit) Responses to the Assessment Questionnaire Most Recent SF-50 (indicating time in grade, highest grade and step attained Note: Current or former Federal employees MUST submit a copy of their SF-50 Form which shows competitive service appointment ("position occupied" block 34 on the SF-50 should show a "1"), tenure group (block 24 should show a 1 or 2), grade, and salary.
• If you are applying for a higher grade, please provide the SF-50 Form which shows the length of time you have been in your current/highest grade (examples of appropriate SF-50s include promotions, With-in Grade/Range Increases, and SF-50s dated a year apart within the same grade/job).
• If you have promotion potential in your current position, please provide proof.
• Employees applying with an interchange agreement must provide proof of their permanent appointment.
• FAILURE TO SUBMIT ALL OF THE REQUIRED DOCUMENTATION, COULD AFFECT YOU RECEIVING CONSIDERATION AS A STATUS CANDIDATE.
• Applicants may also submit the following supporting document type(s), which may not be required for all applicants: Other Supporting Documents: (Only submit if applicable to you) Veterans' Preference documentation - If you are a veteran, you must submit a copy of your DD Form 214, Certificate of Release or Discharge from Active Duty (Member Copy - 4) and, if applicable, and Application for 10-Point Veterans Preference and an official document dated 1991 or later, from the Department of Veterans Affairs or from a branch of the Armed Forces that supports your claim.
• Career Transition Program (CTAP) and Interagency Career Transition Assistance Program (ICTAP) Documentation: If you are a displaced or surplus Federal employee eligible for consideration under the CTAP or ICTAP, you MUST submit proof of eligibility.
• Appropriate documentation such as a reduction-in-force (RIF) separation notice, an SF-50 reflecting your RIF separation, or a notice of proposed removal for declining a directed reassignment or transfer of function to another commuting area.
• You MUST also submit documentation to reflect your current (or last) performance rating of record along with your application package.
• Those eligible for consideration will need to be rated as well-qualified at 85.0 or above on the rating criteria for this position in order to exercise selection priority.
• For more information about ICTAP, go to: ***
• Schedule A: USAJOBS Help Center - Individuals with disabilities - Letter from a physician, local, state or federal rehabilitation office citing eligibility under 5 CFR 213.3102 (u).
• Financial Disclosure: This position may be subject to financial disclosure requirements and must be filed within 30 days of the appointment.
• For more information about Financial Disclosure and OGE Form 450, you may visit U.S. OGE Completing a Confidential Financial Disclosure Report (New Filers).
• You can obtain a fillable OGE Form 450 from: Confidential Financial Disclosure Report (accessible PDF).
• Your Resume must clearly articulate how your skills and experiences align to the criteria defined in the qualifications section of this announcement and it must support your responses to the assessment questionnaire.
• For each position you must describe your duties, accomplishments, related skills, and responsibilities.
• Your resume must also include the month and year that you began and ended for each position held.
• Full-time employment will be assumed unless otherwise stated on your resume.
• Part-time employment will be prorated in crediting experience.
• Not providing this information may result in the lowering of your assessment score or an ineligible rating.
• Please limit your resume to 2 pages.
• For resume writing guidance, please visit the USAJobs Resource Center.
• For additional résumé and application tips: For information on how to build or upload a resume, as well as other resume topics, visit the USA Jobs resume help: USA Jobs Help: Resume You can also watch: USA Jobs: 5 Tips for Communicating Your Qualifications for additional information.
• APPLICATION MATERIALS MUST BE RECEIVED BY 11:59 pm (EASTERN TIME) ON 09/21/2026.

What to expect next

Once the online questionnaire is received you will receive an acknowledgement email that your submission was successful. The most highly qualified candidates will be referred to the hiring manager for further consideration and possible interview.

You will receive notice via email or by mail, if no email address was provided by you during the application process, once this process is completed.

Additional information

Recruitment Incentives: Payment for relocation expenses will not be authorized for this position. A recruitment bonus will not be offered. Repayment of student loans will not be offered.

Private sector work experience will not be approved as credit for your Annual Leave accrual. Security and Background Requirements: A background security investigation will be required for all appointees. Appointment will be subject to the applicant's successful completion of a background security investigation and favorable adjudication.

Failure to successfully meet these requirements may be grounds for appropriate personnel action.

In addition, if hired, a background security reinvestigation or supplemental investigation may be required at a later time. Applicants are also advised that all information concerning qualifications is subject to investigation. False representation may be grounds for non-consideration, non-selection and/or appropriate disciplinary action.

E-Verify: If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System.

Federal law requires DHS to use the E-Verify System to verify employment eligibility of all new hires, and as a condition of continued employment obligates the new hire to take affirmative steps to resolve any discrepancies identified by the system. The U.S. Department of Health and Human Services is an E-Verify Participant.

Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choosing. EEO Statement: HHS is an equal opportunity employer.

Selection for this position will be based solely on merit without regard to race, color, religion, age, gender, national origin, political affiliation, disability, sexual orientation, marital or family status, or other differences. Disabled Veteran Leave: HHS OIG participates in the Wounded Warrior Federal Leave Act of 2015.

To learn more about this benefit, please go to: Disabled Veteran Leave (opm.gov). Fair Chance to Compete for Jobs Act ("Fair Chance Act"): The Fair Chance to Compete for Jobs Act (FCA) prohibits federal agencies from requesting an applicant's criminal history record prior to extending a conditional offer of employment.

In accordance with 5 U.S. Code § 9202(c) and 5 C.F.R § 920.201 certain positions are exempt from the provisions of the FCA. Applicants who believe they have been subjected to a violation of the FCA may submit a written complaint to the Department by email at ***.

HHS has a critical preparedness and response mission: HHS protects the American people from health threats, researches emerging diseases, and mobilizes public health programs with domestic and international partners.

In support of this mission, HHS offers its employees the opportunity to volunteer to become Federal Civilian Detailees and contribute their unique skills through voluntary temporary assignments to humanitarian emergencies or Departmental priorities countering new and emerging health, safety, and security threats.