Medicaid Fraud Oversight Specialist

About this role

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.