Field Investigator - Region 11

Texas Health & Human Services Commission•Edinburg, TX

13d•$4,263 - $5,521

About The Position

The Office of Inspector General (OIG) Benefits Program Integrity (BPI) Field Investigator conducts complex administrative and criminal investigations into suspected fraud, waste, and abuse by recipients of HHS program services, including Medicaid, CHIP, SNAP, TANF, and WIC. Reporting to the BPI unit manager, the investigator researches allegations, gathers and evaluates evidence, and determines whether findings establish violations of applicable program laws, rules, or regulations under the relevant evidentiary standards. The investigator reviews records and reports from agency, state, and federal databases; works with internal and external stakeholders to obtain evidence and verification; applies program eligibility requirements; calculates and establishes overpayment claims; obtains business-record affidavits; submits subpoena information; and coordinates with law enforcement and other government entities. Investigative work may include interviews, locating involved parties, and surveillance. The investigator presents evidence and testifies in administrative hearings and criminal proceedings. The role also includes preparing and delivering training, reviewing or developing investigative techniques, contributing to policies and procedures, and recommending process improvements. The investigator may assist the Electronic Benefits Trafficking division with covert investigations. The position works under limited supervision, with considerable latitude to use initiative and independent judgment. It requires 70% travel and a valid driver’s license.

Requirements

Graduation from an accredited high school or GED.
Graduation from an accredited four-year college or university, or two years of experience conducting administrative or criminal investigations.
Valid driver’s license.
Knowledge of office management and HHS administrative procedures; investigative principles and techniques; administrative hearing and court procedures and rules of evidence; relevant state and federal laws, regulations, and policies; and HHS social services programs and eligibility requirements.
Strong oral and written communication skills, including investigative interviewing and interrogation, legal research and analysis, and testimony.
Ability to use computer and laptop equipment and applicable software, including Excel and other Office Suite applications for data analysis and complex reporting.
Ability to perform sophisticated budget calculations and use mathematical formulas.
Ability to manage competing priorities and deadlines, build effective working relationships, organize research and evidence, and conduct multiple complex investigations simultaneously.
Ability to interpret and apply laws, regulations, agency policies, and guidelines and assess employee or recipient compliance.
Ability to compile and evaluate findings and prepare detailed, high-quality investigative reports for hearings and criminal prosecution.
Ability to present factual and convincing testimony in hearings or court proceedings.
Ability to develop training materials and instruct and train others.
Willingness to travel up to 70%.

Nice To Haves

Experience applying SNAP, TANF, and/or Medicaid policies, procedures, and regulations.

Responsibilities

Research, collect, and examine evidence and records using agency, state, and federal systems to investigate suspected fraud and determine program compliance.
Coordinate complex investigations and exchange information with internal and external stakeholders, law enforcement, and other state and federal agencies.
Conduct subject, witness, and collateral interviews and use other evidence-gathering techniques to meet applicable evidentiary standards.
Evaluate, summarize, and document investigative findings; prepare correspondence and complex investigative reports.
Analyze client activities for compliance with statutory standards and regulations, research legal aspects of cases, and recommend appropriate action.
Provide information for subpoena preparation and service; prepare cases for hearings or court; present evidence and testify in formal proceedings.
Calculate overpayments across programs and establish intentional program violation overpayment claims.
Track adjudication and disposition actions, initiate restitution collection, and coordinate disqualifications as applicable.
Maintain clear investigative documentation and organized electronic filing systems; manage multiple investigations and plan travel and field activities.
Respond to inquiries and correspondence from individuals involved in investigations, using investigative interviewing techniques to obtain relevant information.
Recommend and implement improvements to investigative processes and documentation in coordination with BPI leadership.
Follow confidentiality requirements and records-retention schedules; may review completed investigations, monitor trends and statistics, prepare training, contribute to policy and job-aid development, and assist with automated system testing.
Attend work regularly and predictably and perform other duties as assigned.
May assist the Electronic Benefits Trafficking division with covert benefits-trafficking investigations.