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Medicaid Fraud Inspector Jobs (NOW HIRING)

Jawonio

QA Specialist

New City, NY · On-site

$62K/yr

... site inspections. • Conduct thorough investigation into various types of incidents both ... the Medicaid Fraud & Abuse clearance process. • On-going training/education as part of ...

Jawonio

QA Specialist

New City, NY · On-site

... inspections. · Conduct thorough investigation into various types of incidents both reportable and ... Medicaid Fraud & Abuse clearance process. · On-going training/education as part of development ...

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Medicaid Fraud Inspector information

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 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 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.

More about Medicaid Fraud Inspector jobs
What cities are hiring for Medicaid Fraud Inspector jobs? 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 job categories do people searching Medicaid Fraud Inspector jobs look for? The top searched job categories for Medicaid Fraud Inspector jobs are:
Medicaid Fraud Inspector jobs near you
Infographic showing various Medicaid Fraud Inspector job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 18% Part Time, and 1% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

Inspector General

Oklahoma Human Services

Oklahoma City, OK • On-site

$130K/yr

Full-time

Re-posted 17 days ago

Oklahoma Department Of Human Services rating

6.3

Company rating: 6.3 out of 10

Based on 58 frontline employees who took The Breakroom Quiz

758th of 844 rated public administrative organizations

Job description

Inspector General E10C ES
This position is located in Oklahoma City, Oklahoma.
Annual Salary: $130,273.93 + Full State Employee Benefits
Travel is EXTENSIVE- Must possess a valid driver's license and must maintain required car insurance.
Job Description:
The Oklahoma Human Services (OKDHS) is seeking an Inspector General based in Oklahoma City, Oklahoma. This senior law enforcement executive serves as the head of the Office of Inspector General and Office of Background Investigations, providing independent oversight of agency programs with a focus on preventing, detecting, and investigating fraud, waste, and abuse.
The Inspector General leads a multidisciplinary team of law enforcement officers, investigators, auditors, and support staff to protect program integrity, safeguard vulnerable populations, and ensure accountability for public funds. This role requires strong executive leadership, investigative expertise, and unwavering independence and integrity.
Minimum Qualifications:
Applicants must meet all the following requirements:
  • Education: Bachelor's degree in criminal justice, public administration, business administration, accounting, law, or a closely related field
  • Experience: Seven (7) years of progressively responsible professional experience in law enforcement, investigations, legal, audit, or public administration, including four (4) years in a supervisory or administrative leadership capacity - NOTE: No substitution is permitted for the required supervisory experience

Preferred Qualifications:
  • Advanced degree (J.D., M.P.A., M.B.A., M.S. in Criminal Justice or Forensic Accounting, or equivalent)
  • Law Enforcement Certification: Active CLEET (Council on Law Enforcement Education and Training) certification, OR a valid out-of-state law enforcement certification eligible for reciprocal CLEET certification within the required probationary period
  • Certified Inspector General (CIG) designation from the Association of Inspectors General (AIG)
  • Certified Fraud Examiner (CFE) designation from the Association of Certified Fraud Examiners (ACFE)
  • Certified Internal Auditor (CIA) or Certified Public Accountant (CPA)
  • Direct experience leading program integrity operations in a state human services agency, federal agency, or large public sector organization
  • Working knowledge of federal program integrity requirements for SNAP (FNS), Medicaid (CMS), TANF, and Child Care (ACF)
  • Experience with data analytics platforms and predictive modeling for fraud detection
  • Experience managing Medicaid Fraud Control Unit partnerships or federal grant-funded investigative programs
  • Familiarity with PARIS, SAVE (Systematic Alien Verification for Entitlements), and other federal data-matching programs

Job Duties
  • Direct and oversee statewide program integrity operations across all OKDHS benefit programs, including SNAP, TANF, Medicaid/SoonerCare, Child Care Assistance, Child Support Services, and Child Welfare Services, ensuring effective fraud prevention, detection, investigations, quality control, audits, and compliance to safeguard state and federal resources.
  • Develop and execute a risk-based fraud detection strategy using data analytics, predictive modeling, and pattern analysis; oversee EBT trafficking investigations, the PARIS program, investigative evidence management, and case documentation to identify improper payments, support successful administrative and criminal enforcement actions, and ensure compliance with prosecutorial standards.
  • Lead and supervise commissioned law enforcement officers conducting criminal fraud investigations, administrative violation inquiries, internal affairs investigations, and other criminal matters involving employee misconduct, contractor fraud, provider fraud, recipient fraud, and crimes affecting OKDHS programs.
  • Oversee the full lifecycle of criminal investigations, including case intake, fraud referrals, warrants, subpoenas, court orders, prosecution referrals, case documentation, and expert testimony, ensuring timely resolution of credible allegations and compliance with applicable criminal procedure and evidentiary standards.
  • Serve as OKDHS's primary liaison with the Oklahoma Attorney General's Medicaid Fraud Control Unit (MFCU), the Centers for Medicare & Medicaid Services (CMS), and other federal oversight agencies to coordinate program integrity initiatives, investigations, audits, reporting, and regulatory compliance.
  • Build and maintain collaborative partnerships with local, state, and federal law enforcement agencies-including the FBI, USDA Office of Inspector General, HHS Office of Inspector General, U.S. Attorney's Offices, District Attorneys, and the Oklahoma Attorney General's Office-representing OKDHS in joint investigations, interagency task forces, and statewide anti-fraud initiatives.
  • Provide executive leadership for the Office of Inspector General (OIG) and Office of Background Investigations (OBI), overseeing investigative, audit, background investigation, and administrative operations while establishing strategic priorities, performance measures, and agency-wide program integrity objectives.
  • Direct organizational operations by managing budgets, federal grant funding, staffing, and workforce development; implementing fraud prevention and detection initiatives; overseeing statewide fingerprint-based background investigations; and reporting program outcomes, recoveries, and recommendations to executive leadership and oversight bodies.
  • Advise executive leadership by providing objective, evidence-based findings and recommendations to strengthen program integrity, regulatory compliance, enterprise risk management, and fraud prevention while monitoring emerging risks, legislative changes, and industry best practices.
  • Ensure organizational compliance by developing and maintaining OIG policies, procedures, and professional standards; overseeing compliance with applicable state and federal laws, oversight mandates, and law enforcement requirements; and ensuring the timely submission of all required federal reports and audit responses.

Knowledge, Skills, Abilities and Competencies
The ideal candidate possesses extensive knowledge of administrative investigations, criminal law, and the state and federal regulations governing public assistance programs, along with expertise in fraud prevention, data analytics, financial oversight, and forensic accounting principles. This individual demonstrates exceptional leadership, communication, and relationship-building skills, with the ability to lead multidisciplinary teams, collaborate effectively with law enforcement and government partners, and present complex investigative findings to executive leadership and prosecutors. Success in this role requires sound judgment, unwavering integrity, strict confidentiality, professional independence, and a strong commitment to protecting public resources, ensuring program integrity, and safeguarding the vulnerable populations served by OKDHS.
Physical Demands and Work Environment:
This position includes a combination of office and field work, and requires extensive statewide travel. Applicants must possess a valid Oklahoma driver's license and maintain current automobile liability insurance as required by Oklahoma law. This position is designated as safety sensitive in accordance with 63 O.S. § 427.8.This position is not eligible for telework. This position may be required to work evenings and weekend, as needed.
If you have questions, please contact [email protected]
OKDHS is a Fair Chance Employer.
This is a position in Executive Management, not subject to Oklahoma Civil Service rules.
Announcement Number: 26-KM123
83011488/JR61887

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