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Medicaid Fraud Inspector Jobs (NOW HIRING)

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Provider Fraud Investigator

Lincoln, NE · On-site

$25.61/hr

Under limited supervision, investigates suspected Medicaid provider fraud and program abuse by ... Inspector General, FBI and other appropriate law enforcement agencies; presents cases to ...

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Medicaid Fraud Inspector information

What does a Medicaid Fraud Inspector do?

A Medicaid Fraud Inspector investigates allegations of fraud, waste, and abuse within the Medicaid program. Their responsibilities include reviewing claims, gathering evidence, interviewing witnesses, and collaborating with law enforcement agencies to identify and stop fraudulent activities. They help ensure that Medicaid funds are used appropriately and that providers and recipients comply with all relevant laws and regulations. By preventing fraud, they protect both taxpayers and vulnerable populations who rely on Medicaid services.

What are the key skills and qualifications needed to thrive as a Medicaid Fraud Inspector?

To thrive as a Medicaid Fraud Inspector, you need a strong background in criminal justice, finance, or healthcare, often supported by a relevant degree and investigative experience. Familiarity with data analysis software, case management systems, and knowledge of Medicaid regulations and fraud detection techniques is essential. Attention to detail, critical thinking, and strong communication skills help inspectors effectively analyze evidence and coordinate with law enforcement agencies. These skills ensure accurate identification, investigation, and prevention of fraudulent activities to protect public funds and maintain program integrity.

What are some common challenges faced by a Medicaid Fraud Inspector, and how can they be addressed?

Medicaid Fraud Inspectors often encounter challenges such as navigating complex healthcare regulations, analyzing large volumes of data, and dealing with uncooperative individuals during investigations. Staying current with ever-evolving policies and maintaining attention to detail are crucial for success in this role. Collaborating closely with legal teams, healthcare providers, and law enforcement helps address these challenges and ensures thorough investigations. Ongoing professional development and training in investigative techniques can also support inspectors in overcoming these obstacles.

What is the difference between Medicaid Fraud Inspector vs Medicaid Investigator?

AspectMedicaid Fraud InspectorMedicaid Investigator
CredentialsTypically requires certifications like CFE or CPAOften requires similar certifications, sometimes with additional law enforcement credentials
Work EnvironmentGovernment agencies, healthcare compliance departmentsLaw enforcement agencies, government offices
Employer & IndustryState Medicaid agencies, healthcare organizationsState or federal law enforcement, Medicaid fraud units
Search & Comparison IntentHigh overlap in fraud detection and compliance rolesFocuses more on investigation and enforcement actions

Medicaid Fraud Inspectors primarily focus on auditing and detecting fraud within Medicaid programs, often working in compliance roles. Medicaid Investigators tend to conduct in-depth investigations, often with law enforcement authority. Both roles require similar credentials and work within government or healthcare settings, but their core functions differ in scope and enforcement authority.

How hard is it to become a Medicaid Fraud Inspector?

Becoming a Medicaid Fraud Inspector typically requires a background in criminal justice, auditing, or healthcare compliance, along with relevant experience. Many positions require a bachelor's degree and knowledge of Medicaid policies, with some roles benefiting from certifications such as Certified Fraud Examiner (CFE). The process involves applying for government or agency positions, passing background checks, and sometimes completing specialized training.

How to become a Medicaid Fraud Inspector?

To become a Medicaid Fraud Inspector, candidates typically need a bachelor's degree in criminal justice, healthcare administration, or a related field. Relevant experience in auditing, investigations, or healthcare compliance, along with knowledge of Medicaid policies, is important; some roles may require certification such as the Certified Fraud Examiner (CFE). Professional skills in investigation, data analysis, and attention to detail are essential for success in this role.

What qualifications do you need to be a Medicaid Fraud Inspector?

To become a Medicaid Fraud Inspector, candidates typically need a bachelor's degree in criminal justice, healthcare administration, or a related field. Relevant experience in auditing, investigations, or healthcare compliance, along with knowledge of Medicaid policies and regulations, is also important; some roles may require certification such as the Certified Fraud Examiner (CFE).
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Cities with the most Medicaid Fraud Inspector job openings:

What states have the most Medicaid Fraud Inspector jobs?

States with the most job openings for Medicaid Fraud Inspector jobs include:

What are popular job titles related to Medicaid Fraud Inspector jobs?

For Medicaid Fraud Inspector jobs, the most frequently searched job titles are:

Medicaid Fraud Inspector jobs near you
Infographic showing various Medicaid Fraud Inspector job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 80% Full Time, 18% Part Time, and 1% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

Assistant Attorney General (Medicaid Fraud Unit)

State of Oregon

Portland, OR • On-site

$9.0K - $17K/mo

Full-time

Posted 23 days ago

State Of Oregon rating

8.2

Company rating: 8.2 out of 10

Based on 86 frontline employees who took The Breakroom Quiz

4th of 50 rated states

Job description

Initial Posting Date:
08/05/2026
Application Deadline:
09/17/2026
Agency:
Department of Justice
Salary Range:
$9,063 - $17,597
Position Type:
Employee
Position Title:
Assistant Attorney General (Medicaid Fraud Unit)
Job Description:
This recruitment has been extended to develop a larger pool of candidates. If you already applied there is no need to apply again, your application remains under consideration.
Civil Enforcement Division, Medicaid Fraud Unit
The Civil Enforcement Division of the Oregon Department of Justice is seeking an outstanding attorney to join the Department of Justice's Medicaid Fraud Unit (MFU) in the Portland office.
The MFU investigates and prosecutes health care fraud committed by Medicaid providers and abuse, neglect and financial exploitation in connection with the delivery of health care services. The Oregon MFU consists of 18 FTEs including attorneys, auditors, investigators, data analysts, a paralegal and an administrative assistant. The MFU operates on a federal grant and is 75% federally funded. The Oregon MFU team handles both civil and criminal prosecutions. This specific posting is for an attorney focused on civil litigation. The successful candidate will be handling a range of cases involving all types of Medicaid providers including in-home caregivers, licensed medical professionals, care facilities, pharmacies, durable medical equipment suppliers and pharmaceutical companies. This position will work closely with other state Medicaid Fraud Control Units on multi-state litigation. The successful candidate will also have extensive experience filing and litigating civil plaintiff matters in Oregon courts. This position will collaborate closely with a variety of local, state and federal law enforcement agencies including the U.S. Attorney's Office and the Health and Human Services - Office of Inspector General.
If selected, you will be responsible for handling a high-intensity, diverse and challenging caseload. You will be expected to work in a multi-disciplinary team to investigate complex billing fraud allegations from inception through resolution. You will be evaluating incoming referrals; obtaining and reviewing evidence; identifying and interviewing witnesses; handling depositions; managing voluminous discovery; motion practice; negotiating with defense counsels and trying cases.
Questions regarding this position may be directed to Sheen Wu, Attorney-In-Charge, Medicaid Fraud Unit, at sheen.wu@doj.oregon.gov.
Required
  • Active membership in good standing with the Oregon State Bar or reciprocity in progress at the time of application.
  • A minimum of seven (7) years of civil litigation experience including handling complex discovery, motion practice, and first chair trial experience.
  • Superior analytical, advocacy, research, verbal communication, and writing skills.
  • Good judgment and a strong work ethic, including the ability to work equally well independently and as a productive team member.
  • Proficiency with technology.
  • Willing and available to travel throughout the State for court appearances and other case-related work, including overnight stays away from home-must have valid driver's license.

Requested:
  • Experience with the healthcare industry such as experience with the Medicaid program; managed care organizations; commercial health plans, etc.
  • Experience building and pursuing a civil plaintiff's case.

Additional applicant screening will depend on the number of qualified applications received. Applicants most closely matching the requirements and needs of the position will be invited to interview. If you are selected to interview and require a particular accommodation during the interview, please inform the person scheduling the interview.
Application Process
Follow the "Apply" link above and complete the application online and all supplemental questions;
  • Attach your resume;
  • Attach your cover letter (detailing how you meet the job requirements); and
  • Attach your writing sample suitable for assessing analytical and writing ability. A writing sample is not needed from attorneys currently working at the Oregon Department of Justice at the time of application. However, a copy may be requested at a later date if needed.

This OAJA-represented position will be filled at either the Assistant Attorney General or Senior Assistant Attorney General level, salary range $9,063.00 - $17,597.00 per month, depending primarily on years of legal practice experience and other factors. Employees who are Public Employee Retirement System (PERS) participating members will have their base salary increased by 6.95% and pay a 6% employee contribution to PERS; the salary range noted reflects base salary only.For a partial list of our benefits, you can learnhere
ALL APPLICANTS: You will only have one opportunity to upload the required resume and cover letter. Drag and drop both resume and cover letter into Workday when prompted to upload your resume. If you are concerned that one or both requested documents didn't attach to your application, if you need an accommodation under the Americans with Disabilities Act (ADA), have questions, or need assistance with the application process, please contact doj.recruitment@doj.oregon.gov. Any materials emailed will be associated on your behalf if received before the posting deadline.
CURRENT STATE EMPLOYEES: Login to Workday using your state-issued login and apply via the Jobs Hub Worklet located on your home page. Using a private account disrupts the hiring process for all internal candidates.
The Department of Justice
The Mission of the Oregon Department of Justice is to serve state government and to support safe and healthy communities throughout Oregon by providing essential justice services. Its over 1,600 employees in ten divisions, including nearly 400 lawyers, are dedicated to the rule of law and serving the people of Oregon and its government.
The Attorney General and our ten divisions are dedicated to:
  • Providing ethical, independent and high quality legal services to state government;
  • Safeguarding consumers from fraud and unfair business practices;
  • Fighting crime and helping crime victims;
  • Advocating for vulnerable children;
  • Supporting families through the collection of child support;
  • Enforcing environmental protections;
  • Defending the civil rights of all Oregonians;
  • Pursuing justice and upholding the rule of law.

Working for the Department of Justice
Assistant Attorneys General, on behalf of the Attorney General, represent the State of Oregon and state-elected and appointed officials, agencies, boards and commissions in most civil and many criminal proceedings. The Department offers a broad range of opportunities for attorneys to work on significant and complex issues that face our state and make a difference to the citizens of Oregon while providing unparalleled career satisfaction and professional prospects.
Conduct Expectations
The role of the Oregon Department of Justice is to provide justice and uphold the rule of law. Employees of the Department are required to meet the highest standards of professional conduct and ethics while on the job, and also to maintain those same high standards when taking actions in their personal lives that could reflect on the Department.
Diversity is a core value of the Department of Justice and the department's Civil Enforcement Division. We are working to build and maintain a diverse, inclusive, and equitable work environment. Every employee expands our diversity through varied experiences and perspectives, and by contributing to the range of ways to understand and communicate with one another, identify challenges, and work cooperatively.
Candidates from diverse backgrounds are encouraged to apply. The Department of Justice is an equal opportunity employer, does not discriminate based on race, color, national origin, ethnicity, veteran, gender, sexual orientation, religion, age or disability, and is committed to workplace diversity.
For additional information regarding working for the Department of Justice and application assistance, click HERE.
Oregon Department of Justice
1162 Court St NE
Salem OR, 97301
DOJ.recruitment@doj.oregon.gov
Phone: (503) 947-4328
Fax: (503) 373-0367

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About State of Oregon

Sourced by ZipRecruiter

Not a traditional company, the State of Oregon is a governmental entity that serves the citizens of Oregon, United States. Based in the capital city of Salem, its industry spans a wide range of public services from health care, education, and transportation, to natural resources, housing, and public safety. Founded with the admission of Oregon to the Union in 1859, it operates on the judicious use of finite resources to enhance the quality of life for present and future generation. Its primary mission is to serve the public through their core values of integrity, accountability, excellence, and equity.

Industry

Public administration

Company size

10,000+ Employees

Headquarters location

Salem, OR, US

Year founded

1859

Social media

Twitter

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