Research Specialist III

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Functional Title: Research Specialist III 
Job Title: Research Specialist III 
Agency: Health & Human Services Comm 
Department: Med Svcs - Acute Care Intake 
Posting Number: 10824 
Closing Date: 11/13/2025 
Posting Audience: Internal and External 
Occupational Category: Office and Administrative Support 
Salary Group: TEXAS-B-20 
Salary Range: $4,263.16 - $5,521.16 
Pay Frequency: Monthly
Shift: Day 
Additional Shift: Days (First) 
Telework: Eligible for Telework 
Travel: Up to 10% 
Regular/Temporary: Regular 
Full Time/Part Time: Full time 
FLSA Exempt/Non-Exempt: Nonexempt 
Facility Location:  
Job Location City: AUSTIN 
Job Location Address: 4601 W GUADALUPE ST 
Other Locations:  
MOS Codes: 0231,0531,4505,4591,8051,8825,8850,15AX,35F,38A,49A,683X,783X,CYB14,IS,ISS,OSS 
 
 
 

Please note: This position may require in person office presence. Applicants must live in Austin, TX or the surrounding area.

The Office of Inspector General’s (OIG’s) mission is to improve the health, safety, and well-being of Texans through good stewardship of public resources, with a focus on core public health functions. OIG is a dynamic organization that specializes in the prevention, detection, audit, inspection, review, and investigation of fraud, waste, and abuse in the provision and delivery of state health and human services programs and enforces state law related to the provision of those services. The OIG’s Data Reviews division leverages data and technology to build tools and processes that effectively and efficiently prevent, detect and deter fraud, waste and abuse within Texas Medicaid and other health care programs, helping ensure that taxpayer funds for health and human services are spent properly.

The Targeted Query (TQ) Research Specialist III is selected by and reports to the TQ Manager within the OIG’s Data Reviews division. The position is responsible for conducting retrospective payment reviews of Texas Medicaid billing and reimbursement data and coordinating with providers and payors to resolve potential improper payments. The position performs research using multiple data sources across a wide array of provider types and services to identify, deter, and prevent potential fraud, waste, and abuse in the Medicaid program, using comparative analysis of Texas Medicaid policies and paid claims data to develop, design, plan, conduct, and coordinate data-informed research to validate and test provider compliance with published Medicaid policies, rules, and regulations. The TQ Research Specialist uses billing and reimbursement data, Texas Medicaid policy, and information from other sources to review trends and patterns of potential aberrant provider billing activity, evaluate outcomes, and collaborate with both internal and external parties to educate providers and collect overpayments. The TQ Research Specialist is responsible for researching legislation, state and federal laws and regulations, and policies and procedures relevant to Texas Medicaid and Data Reviews and for preparing reports of research findings. The position may serve as a research consultant to other OIG staff, vendors, Office of Attorney General Medicaid Fraud Control Unit or Healthcare Program Enforcement Division personnel, and other state and federal agency staff. The position works with a team of other research specialists and OIG fraud analysts to analyze, establish, recommend, and update procedures for the identification of inappropriately paid claims and/or policy violations.

The position works under limited supervision, with moderate latitude for the use of initiative and independent judgment.

The position will perform other duties as assigned. The position requires up to 10% travel with infrequent overnight stays. May require work hours other than 8 a.m. to 5 p.m. Requires viewing computer screens for long periods of time, up to six or more hours per day.  

Essential Job Functions:

Performs advanced technical research and in-depth comparative analysis of Medicaid policies and paid claims data to identify, deter, and prevent potential fraud, waste, and abuse in the Medicaid program. (30%)

Develops, designs, plans, conducts and coordinates retrospective payment reviews to validate provider compliance with published Medicaid policies, rules, and regulations. Queries, organizes, and presents data reports that clearly demonstrate improper payments based on Texas Medicaid requirements. Coordinates with Medicaid providers and payors to recover overpayments, ensuring that correspondence and data reports are clear, accurate, and educational and that all research and communication related to reviews is thoroughly documented in applicable  systems according to division policies and procedures. (35%)

Serves as a policy and data research consultant, assisting in the establishment of analytical methodologies and recommending improvements to data analysis used in the identification of inappropriately paid claims and/or Texas Medicaid policy violations. Provides research support to both internal and external partners, including other OIG division areas, Office of Attorney General personnel, vendors and other state and federal agency staff, as needed. Reviews and responds accurately and timely to inquiries regarding legislation, state and federal regulations, and policies and procedures impacting Medicaid and OIG. Recommends enhancements to policies, procedures, and processes. Coordinates with other OIG staff regarding projects and in planning, designing, conducting data collection, and identifying subject selection for review. (20%)

Provides excellent customer service to TQ personnel and stakeholders, takes initiative to proactively identify opportunities for improvement, and designs solutions to address team challenges and barriers. Performs other duties as assigned, keeping division leadership informed as appropriate. (15%)

Registrations, Licensure Requirements or Certifications:

None

Knowledge Skills Abilities:

• Knowledge of state and federal laws and regulations relevant to Medicaid and other public health care programs.
• Knowledge of data analysis and research concepts and techniques and their application to performance measurement.
• Knowledge of research methods, principles, techniques, and philosophies.
• Knowledge of systems and procedures used to test and evaluate project performance.
• Ability to plan, organize, manage, and coordinate research projects.
• Ability to evaluate research data and findings.
• Ability to ensure development of measuring instruments with respect to reliability, relevance, and validity.
• Ability to interpret, publish, and present research findings.
• Ability to communicate effectively, both orally and in writing.
• Ability to coordinate activities among public, private, and professional groups, express ideas clearly and concisely, address audiences effectively, and exercise sound judgment in evaluating situations and making decisions.
• Skill in conducting qualitative and quantitative research.
• Skill in the use of Microsoft Office Suite products, including Outlook, Word, Excel, PowerPoint, and Teams.
• Proficiency in using data querying and analysis tools, including Microsoft Excel, to analyze and produce clear and accurate data reports.
• Skill in researching, developing, and writing professional reports and/or presentation materials.
• Skill in project management, including prioritization and workflow management, to successfully achieve results within project deadlines.
• Skill in problem solving and independent decision making.
• Skill in leading staff work processes, setting priorities, and monitoring progress.
• Skill in developing and evaluating policies and procedures; assessing risks and developing contingency plans; and making recommendations for improvement.
• Skill in synthesizing complex and technical information and translating it into understandable and concise documents and presentations.
• Skill in interpersonal relationships, including the ability to work with people under pressure, negotiate among multiple parties, resolve conflicts, and establish and maintain strong and effective working relationships.

Initial Screening Criteria:

At least two years of experience working with Microsoft Office suite products, especially Excel, is required.

At least two years of research and planning experience in healthcare, Medicaid, or other health and human services programs is required.

Experience working with Texas Medicaid managed care programs is preferred. 

Graduation from an accredited four-year college or university is preferred.

Additional Information:

• The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS in Medicaid and other HHS programs.  Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must complete a national fingerprint-based criminal background check through the Texas Department of Public Safety (DPS) and Federal Bureau of Investigation (FBI) to determine if they have criminal history record information that constitutes a bar to employment.

Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.