Health Care Fraud Investigative Analyst

Summary

This is a permanent position in the Civil Fraud Section, which pursues health care fraud cases under the False Claims Act. These positions are part of a significant expansion of the data, research, and analytics team in theFraud Section and require combined investigator and data scientist expertise to analyze, manage, and clean large repositories of health care data, including claims and utilization data and informatics, prescription trends, diagnosis data, and clinical outcomes data.

This job is open to
The public

U.S. Citizens, Nationals or those who owe allegiance to the U.S.

Clarification from the agency

This position is being advertised under delegated examining procedures and is open to all U.S. Citizens. Preference for eligible veterans will be applied.

Duties

The duties and responsibilities for a GS-0101-14/15 Health Care Fraud Investigative Analyst generally include, but are not limited to, the following:

Analyzing healthcare data and evaluating healthcare fraud allegations to develop investigative leads.
Providing investigative and data science skills on complex and consequential health care fraud matters.
Developing, testing and refining new and emerging models and analytics to proactively detect potentially fraudulent conduct, providers, and trends.
Working with other Department of Justice components, Department leadership, United States Attorney's Offices, and other federal agencies and contractors involved in healthcare fraud enforcement.
Presenting data and investigative models and findings to the Department's leadership such as the Deputy Attorney General's Office, US Attorney's Office leadership, and client agency leadership.
Working with directors and Department heads to identify priority areas of health care fraud investigations and program vulnerabilities using complex data tools.
Designing complex problem-solving methods to analyze vast amounts of health care claims data to help the Fraud Section detect, prevent, investigate, and litigate False Claims Act healthcare fraud cases.
As the federal agency whose mission is to ensure the fair and impartial administration of justice for all Americans, the Department of Justice is committed to fostering a diverse and inclusive work environment. To build and retain a workforce that reflects the diverse experiences and perspectives of the American people, we welcome applicants from the many communities, identities, races, ethnicities, backgrounds, abilities, religions, and cultures of the United States who share our commitment to public service.

Requirements
Conditions of Employment
You must be a United States Citizen or National.
You will be required to complete a pre-employment security investigation and background check which includes a drug screening.
Selective Service registration is required for males born on, or after, December 31st 1959. Those not registered should have an approved exemption on file.
You must meet all eligibility requirements by the closing date of this announcement and continue to meet these requirements throughout the hiring process. Offers can be rescinded if requirements are not met.
You may be required to complete a one-year probationary.
Qualifications
To qualify for the position of Health Care Fraud Investigative Analyst, (GS-0101-14/15), you must meet the basic qualification requirements listed below AND possess the required specialized experience specific to the series and grade you are applying to.

Candidates must possess one of the following basic requirements to receive consideration for this position: 1) A Bachelor's degree in behavioral or social science such as research, sociology, political science, public health (bio-statistics, health behavior, health systems), health administration, etc. or a related discipline, such as social anthropology.
OR
2) Four years of related experience that demonstrates you have acquired knowledge of one or more of the behavioral sciences equivalent to a major in the field (at least 24 semester hours). This experience must demonstrate that you have the knowledge, skills, and abilities sufficient to perform the work in the occupation.
OR
3) A combination of education as described in 1 above and experience described in 2 above that provides the knowledge of one or more of the behavioral or social sciences equivalent to a major in the field. When combining education with experience, first determine your total qualifying education as a percentage of the education required for the grade level; then determine your experience as a percentage of the experience required for the grade level; finally, add the two percentages. (For example, divide your semester hours by 120 then divide your months of experience by 48; add the two percentages. The total must equal at least 100%.

In addition to the basic requirement, you must meet the minimum qualifications: To qualify for the GS-14,

Health Care Fraud Investigative Analyst, you must have at least one full year of specialized experience equivalent to the GS-13 level in the Federal service: conducting data-driven health care fraud investigations involving alleged violation of federal laws; collaborating amongst a team on health care fraud investigations; conducting quantitative analyses of health care claims data and applying data science, analysis and visualization tools to validate and present data, identify fraud and program weaknesses; experience working with health care claims data and analytical tools such as CMS "OnePI," STARS, and Business Objects; providing written recommendations and data findings to leadership, including objectives and methods for health care fraud data analytics.
To qualify for the GS-15,
Health Care Fraud Investigative Analyst, you must have at least one full year of specialized experience equivalent to the GS-14 level in the Federal service: planning, directing, and conducting data-driven health care fraud investigations involving alleged violation of federal laws; leading a team on health care fraud investigations; conducting quantitative analyses of health care claims data and applying data science, analysis and visualization tools to validate and present data, identify fraud and program weaknesses; experience working with; experience leading work with health care claims data and analytical tools such as CMS "OnePI," STARS, and Business Objects; providing written recommendations and data findings to, leadership, including objectives and methods for health care fraud data analytics.

You MUST meet all qualification requirements by the closing date of this announcement, 02/29/2024.

Your resume must support your responses to the questionnaire and qualification requirements. Failure to do so may result in an ineligible rating.

See the Required Documents section for important notes about what must be included in your resume.
Education

If you are relying on your education to meet qualification requirements:

Education must be reviewed and certified by an accrediting institution recognized by the U.S. Department of Education in order for it to be creditable toward your qualifications. Therefore, you should provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

Foreign Education: If you are using education completed in foreign colleges or universities to meet the qualification requirements, you must show that the education credentials have been evaluated by a private organization that specializes in interpretation of foreign education programs and such education has been deemed equivalent to that gained in an accredited U.S. education program; or full credit has been given for the courses at a U.S. accredited college or university. For more information about this requirement, please visit the U.S. Department of Education website for Foreign Education Evaluation.

All documentation must be in English or include an English translation.

Additional information

CAREER TRANSITION PROGRAMS (CTAP or ICTAP): For more information visit: USAJOBS Career Transition Programs
VETERANS AND MILITARY SPOUSES: Please see USAJOBS Veterans Preference for more details.
REASONABLE ACCOMMODATION: Our policy can be found at: https://www.justice.gov/jmd/eeos/manual-and-procedures-providing-reasonable-accommodation
DOJ EEO STATEMENT: The U.S. Department of Justice fosters an inclusive and diverse workforce, find our EEO statement online at: https://www.justice.gov/jmd/page/file/1394116/download
SELECTIVE SERVICE: If you were born male, on or after December 31, 1959, you must certify that you have registered with the Selective Service System, or are exempt from having to do so under the Selective Service Law. Additional information is found at: www.sss.gov.

Benefits
How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

Your application will be evaluated and rated under DOJ's Category Rating and Selection Procedures. Your resume and supporting documentation will be used to determine whether you meet the job qualifications listed on this announcement. If you are basically qualified for this job, your resume and supporting documentation will be compared to your responses on the Occupational Questionnaire. If you rate yourself higher than is supported by your application materials, your responses may be adjusted and/or you may be excluded from consideration for this job. If it is determined you meet minimum qualification requirements, your application will then be placed in one of three categories: Best Qualified, Highly Qualified, or Qualified. Within these categories, applicants eligible for Veterans' Preference will receive selection priority over non-veteran preference eligibles.

When addressing the specialized experience statement, applicants must present evidence of the experience in their resume. If the specialized experience statement is repeated, in the applicant's resume, Human Resources will deem the applicant as ineligible.

Your qualifications will be evaluated on the following competencies (knowledge, skills, and other characteristics):

Computer Forensics
Criminal Investigation
Oral Communication
Technical Competence

Career Transition Programs (CTAP or ICTAP): These programs apply to Federal and/or DOJ employees who meet the definition of surplus or displaced from a position in the competitive service. To receive selection priority for this position, you must:
Meet CTAP or ICTAP eligibility criteria;
Be rated well-qualified for the position with a score of 85 or above based on the competencies listed above; and
Submit the appropriate documentation to support your CTAP or ICTAP eligibility. most recent performance appraisal, a copy of your written notification of ICTAP eligibility or a copy of our separation personnel action, and most current SF-50 noting position, grade level, tenure, and duty station.

Required Documents

Documentation requirements may vary from applicant to applicant based on your eligibility claims.
For example, Veteran documents would be required only from applicants claiming Veteran's Preference. It is your responsibility to carefully review the list of document descriptions below, to see which documents are required for your application.

ALL APPLICANTS: You must submit a detailed resume containing the following pieces of information for each job entry listed in your employment history:

Official position title,
Employer name and contact information,
Start and end dates (including month and year),
A detailed list of duties & accomplishments,
Your grade/step achieved, and
The number of hours worked per week (or indicate full-time).
If you're unsure about what to include in your resume, please review the USAJOBS Resume Writing Tutorial on YouTube. You are encouraged to use the USAJOBS Resume Builder, as this will ensure you're including everything that is required.

If you are claiming a Veterans Preference eligibility:
When claiming a Veteran's Preference, you must submit your last DD-214 (Certificate of Release or Discharge from Active Duty) form, specifically the Member #4 Copy, indicating dates and character of service and discharge type.
If you are a Veteran with a service-connected disability rating of 30% or more, you will need to additionally submit the SF-15 (Application for 10-point Veterans Preference) and a copy of your VA Letter stating your disability rating.
If you are the qualifying parent or spouse of a disabled, deceased, or deployed Veteran, and are seeking a derived preference eligibility, you must submit appropriate supporting documentation such as the Veterans DD-214, SF-15, VA Letter, and/or Permanent Change of Station (PCS) orders. See Veteran Family Preference for more information.
For more information on each type of Veterans Preference, and the documentation required for each, see FedsHireVets.
If you are a displaced Federal employee claiming eligibility under CTAP or ICTAP:
You must submit your separation notice or agency RIF letter from your agency.
If you have not yet been separated, you can provide the letter of intent to separate you from the agency because of reduction-in-force.
See USAJOBS' Career Transition Programs for more information.
If you are using education to qualify for this position, or education is required:
You must submit a transcript, which may be unofficial, as long as it contains a full listing of courses, credit earned, grade and grade-point-average, subject area, degree(s) earned, and dates of award.
Your transcript must come from a nationally-accredited educational institution recognized by the Department of Education.
If submitting a foreign transcript, you must have the transcript reviewed by an approved foreign education review organization recognized by the Department of Education.
Please do not submit electronic transcripts with documentation security protection, these may prevent our application system from accepting and processing the document.

More Info:
USAJOBS - What documents might I need to provide?
Application Manager - Documents

How to Apply

To apply for this position, you must complete the online application questionnaire and submit your supporting documentation. Your complete application package must be submitted by 11:59 PM (EST) on 02/29/2024 to receive consideration.

Please note that if the vacancy has an application limit, it will be listed at the top of the announcement by USAJOBS, and the closing date may be sooner than listed here.

If you would like to preview the assessment questionnaire, please see: https://apply.usastaffing.gov/ViewQuestionnaire/12309546

Click "Apply Online" to get started.
If you're not logged in to your USAJOBS account, you will need to login. If you don't have an account, please create one.
You will be prompted to select one of your stored (or uploaded) resumes, and any supporting documents you have uploaded to USAJOBS. If you have not uploaded these documents, you can do so later before submitting your application.
After acknowledging you have reviewed your application package, you will be asked to submit your demographic information (if you have provided this in your profile). Submission is optional and anonymous.
You'll be asked to confirm your choices and certify the accuracy of your information before you're able to continue to the Application Manager system. Until you see the blue border and DOJ logo, you are still on USAJOBS. You'll see a folder animation just before you leave USAJOBS.
Once you reach DOJ's Application Manager system, you'll be asked to verify the information you transmitted from USAJOBS. You will then respond to the application assessment questionnaires and indicate your eligibility options.
After responding to the questionnaires, you will have the opportunity to attach the documents you brought over from USAJOBS *OR* upload documents directly from your computer or device.
If you opt to upload a document directly, click the "Upload" button and select the document on your device, then wait for the upload to finish. Repeat as needed. Documents must be less than 3 MB each and should be in a compatible file format.
Once all your documents are uploaded, you must assign the uploads to the appropriate document category. You may attach more than one document to each category. Click the drop-down menu for a document category, and select one of the available options in the menu. The document will be listed under this category. You can click the drop-down again to add other documents, as needed. You can have up to 15 document assignments.
Once you've uploaded and assigned all your documents to an appropriate document type, you can proceed to the final verification step, and click Submit.
If you have correctly submitted your application, you will receive an automated e-mail notification within 30-60 minutes. Be sure to review the announcement fully to make sure that your application contains everything that is required.
If you need help with the application process, please see the USAJOBS Site (for everything on the USAJOBS-side), or the Application Manager Site (for everything on the DOJ-side). Regrettably, the Department of Justice cannot assist you with USAJOBS account issues. If you contact us for assistance and the problem is related to your USAJOBS account, we will have to direct you to USAJOBS to remedy the issue.

REASONABLE ACCOMMODATIONS:
If you are unable to apply online due to a disability or overseas deployment, you must request an alternative application, which is available from the Human Resources Office. Please contact Brandon Cox at brandon.l.cox@usdoj.gov or 202-598-9544 to discuss your situation. Accommodations are reviewed on a case-by-case basis. Indicate that you're asking for a reasonable accommodation in your e-mail subject so the HR Specialist knows where to direct you.

Agency contact information
Brandon Cox
Phone

202-598-9544

Fax

202-514-7968

Email

brandon.l.cox@usdoj.gov

Address

Civil Division
1100 L Street, NW
Washington, DC 20530
US

Next steps

You will receive e-mail notifications as your application status is updated by DOJ. However, you can also see your application status any time by logging in to your USAJOBS account and looking on the "Applications" page. Click the position title to expand the display for each application in the list. Click here to learn more about checking your application status, or see what each application status means.

We strive to extend a final offer of employment within 90 days from the close of this announcement. Delays do sometimes occur for reasons beyond our control.