Fraud Investigator

State of Nebraska • Pending Location Assignment (PLA) - no city, NE

1d • Onsite

About The Position

The Nebraska Department of Health and Human Services (DHHS), Office of Economic Assistance, is hiring a Fraud Investigator to investigate referrals and allegations of suspected fraud in DHHS public assistance programs, including Supplemental Nutrition Assistance, ADC, AABD, and Energy Assistance. Under limited supervision, the investigator audits client and worker records, interviews witnesses, clients, employers, and service providers, consults with DHHS program staff, and determines whether cases should be referred for criminal prosecution or an administrative hearing. The investigator also represents the agency at hearings and court proceedings, handles referrals for overpayment recoupment, and performs related work as assigned.

The role is statewide in Nebraska, subject to space availability, and requires driving. The stated schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m.; dress attire is business casual. The hiring rate is $22.160 per hour, non-exempt.

Requirements

• Post-high-school coursework or training in criminal justice, law, social work, or criminal investigative methods; OR experience in a social service agency with responsibility for eligibility determination in a variety of program areas; OR experience performing investigation, auditing, research, or information-search activities, medical or service-provider billing, claims adjustment review or processing, or service or payment authorization.
• Valid driver's license or the ability to provide independent authorized transportation.
• Knowledge of interviewing principles, practices, and techniques; public assistance programs; and case-management techniques.
• Ability to obtain, record, and document information; learn and apply agency rules and procedures for fraud and abuse investigations; and learn, interpret, and apply State and Federal rules and regulations concerning abuse of social services programs.
• Ability to learn and operate social service computer programs and functions; interact with clients, employees, and criminal justice authorities; and establish working relationships.
• Ability to communicate to gather and relay information, make decisions within established guidelines, conduct interviews with cooperative and uncooperative individuals, solve arithmetic problems, speak before groups, prepare accurate and concise written reports, and explain processes and procedures.

Nice To Haves

• Prior law enforcement or criminal investigation experience.
• Experience completing investigations and writing investigative reports.

Responsibilities

• Conduct audits of files, client records, and computer-generated printouts to identify potential intentional program violations by clients or staff.
• Review case files for completeness, accuracy, and compliance with existing guidelines, and write reports of investigative findings.
• Interview service providers, employers, clients, and third parties to gather information, obtain evidence of fraud or abuse, verify information, and explain applicable law.
• Determine whether a client intended to defraud the agency and whether the matter should be referred for criminal prosecution or an administrative hearing.
• Represent the agency at Intentional Program Violation (IPV) hearings and criminal court proceedings; present evidence and explain the investigation and findings.
• Question witnesses and present the State’s position at IPV hearings.
• Consult with agency employees and witnesses to prepare them for administrative and court appearances.
• Refer warranted overpayments for recoupment when criminal prosecution is not possible and negotiate repayment agreements.
• Serve as a resource to the public and DHHS staff and receive referrals from members of the public, agency and government staff, law enforcement, and school officials.

Benefits

• Comprehensive package of pay, benefits, paid time off, retirement, and professional development opportunities. Benefit eligibility may vary by position, agency, and employment status.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed