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About the Role

Performs highly advanced (senior level) investigative work involving allegations of fraud, waste, and/or abuse in the provision and delivery of all health and human services in the state. This role requires interviewing skills, extensive research & data analysis, advanced investigative skills, and the development of complex investigative reports. Work involves up to 25% statewide travel, which may include some overnight travel. The investigator works minimal supervision with extensive latitude for the use of initiative and independent judgment.

Responsibilities

Research, review, and objectively investigate complex cases alleging fraud, waste, and/or abuse in the provision and delivery of all health and human services in the state.
Interpret and apply applicable agency, state and federal policies, procedures, rules, and regulations.
Perform timely investigative analysis in conformity with applicable policies and procedures.
Evaluate, summarize, and communicate investigative findings through various oral and written communications.
Prepare detailed, comprehensive internal reports.
Develop comprehensive fact-based exhibits to ensure effective case presentations in administrative hearings and court cases, when required.
Testify and present evidence in informal reviews and judicial proceedings (before administrative, civil, and criminal courts) as needed.
Research potential interviewees related to the investigation.
Conduct professional interviews with recipients, witnesses, providers, complainants, and provider’s staff regarding investigations.
Provide law enforcement assistance in criminal fraud cases to criminal investigators and prosecutors when necessary.
Establish liaisons with the Office of Attorney General’s Medicaid Fraud Control Unit, the Healthcare Program Enforcement Division, Managed Care Organizations (MCOs) other state and federal agencies, licensure boards, and other external entities to discuss and/or coordinate complex cases alleging fraud, waste, and/or abuse in the provision and delivery of all health and human services in the state.
Develop, recommend, and implement solutions to problems.
Review, develop, and recommend guidelines, procedures, policies, rules, and regulations to detect and prevent fraud, waste, and program abuse in the provision and delivery of all health and human services in the state.
Self-initiate cases or projects designed to generate cases to prevent, detect and investigate fraud, waste and abuse not reported through the OIG referral process.
Perform other duties as assigned or required to maintain division operation.
Keep manager informed as required or as necessary.

Requirements

Knowledge and experience in complex investigative principles, techniques, and procedures.
Knowledge of the laws governing the activities regulated by the agency, court procedures, rules of evidence, criminal prosecutions, civil actions, and contract law.
Knowledge of Medicaid program policies and procedures.
Knowledge of fraud and abuse rules and regulations.
Knowledge of business structures (corporate, partnership, LLC).
Experience in opens source investigative techniques (OSINT).
Ability to understand, interpret, and appropriately apply policies, procedures, rules, and regulations.
Ability and skill to plan, organize, and conduct complex investigations.
Ability to use data analytics to analyze investigative data.
Ability to use AI for complex searches.
Ability to conduct interviews and gather facts.
Ability to evaluate findings.
Ability to prepare complex, concise reports.
Ability to testify in hearings and court proceedings.
Ability to communicate effectively both orally and in writing.
Ability to establish and maintain effective, professional working relationships with supervisory personnel, team members, MCOs, providers, attorneys and individuals from other state and federal agencies and boards.
Ability to use personal computers and related software to analyze complex queries using advanced functions and formulas in Microsoft Excel, Power BI, and other applications as required.
Ability to prioritize tasks.
Ability to work under time constraints and under minimal supervision.
Ability to travel up to 25% of the time, to include statewide and/or overnight travel.
Ability to multi-task and track multiple activities with competing priorities.
Ability to work independently.
Ability to exercise professional judgment and reach sound decisions.
Ability to integrate complex regulatory concepts, procedures, and processes.
Skilled in creating comprehensive reports.
Skilled in analyzing data insights.
Skilled in developing clear, impactful visualizations.
Skilled in preparing correspondence using Microsoft Word to respond to requests and document investigative findings.
Graduation from an accredited four-year college or university.
Experience may be substituted for the required education on a year-for-year basis up to four years.
Experience in writing detailed reports.
Experience operating personal computers and software.
Experience conducting complex investigations preferred.
Responses to interview questions.
Experience in investigative research and analysis.
Interviewing and report writing skills.
Response to Investigation Example.
Reference checks and background checks.

Skills

Investigative techniques
Data analysis
Interviewing
Report writing
Opens source investigative techniques (OSINT)
Microsoft Excel
Power BI
Microsoft Word

Location

AUSTIN

Work Type

Eligible for Telework
Full time

Experience Level

Senior level
Highly advanced

Education Level

Graduation from an accredited four-year college or university
Certified Fraud Examiner (CFE) certification preferred

Salary/Compensations

$4,801.16 - $7,761.50 Monthly

Benefits

100% paid employee health insurance for full-time eligible employees
Defined benefit pension plan
Generous time off benefits
Numerous opportunities for career advancement

About the Company

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.
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.

Equal Opportunity

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability.
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.