Fraud Investigator

State of Nebraska•Scottsbluff, NE

3d•Onsite

About The Position

The Department of Health and Human Services (DHHS), Division of Children and Family Services is looking for a strategic partner for the position of Fraud Investigator. The successful candidate will participate in and support a culture where employees are highly motivated, energetic, excited, and enthusiastic working for DHHS. This position is in Scottsbluff. Under limited supervision, the Fraud Investigator conducts investigations on referrals and/or allegations related to suspected fraud in DHHS Public Assistance programs such as Supplemental Nutrition Assistance, ADC, AABD, Energy Assistance, etc. Utilizing investigatory skills, performs thorough professional investigations including auditing client and worker records, interviewing witnesses, clients and employers and consulting DHHS program staff. Determines if client case should be referred for criminal prosecution and/or administrative hearing. Performs related work as assigned. “You have the passion; we have the opportunities – let’s make a difference for Nebraskans”

Requirements

Post high school coursework/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, service or payment authorization.
Valid driver's license or the ability to provide independent authorized transportation.
Knowledge of: principles, practices and techniques of interviewing to gather information; public assistance programs; techniques of case management.
Ability to: obtain, record and document information; learn and apply agency rules and procedures regarding fraud and abuse investigations; learn, interpret and apply State and Federal rules and regulations regarding abuse of social services programs; learn and operate social service computer programs and functions; interact with clients, employees and criminal justice authorities to conduct investigations and establish working relationships; communicate with others to relay and gather information; make decisions and take action in dealing with problems and situations within established guidelines; conduct and control interviews to obtain information from cooperative and uncooperative individuals; solve arithmetic problems; speak before groups to present technical information; prepare accurate and concise written reports; explain processes and procedures.

Nice To Haves

Prior law enforcement or criminal investigation experience.
Emphasis on experience involving completing investigations and investigative report writing.

Responsibilities

Conducts audits of files, client records and computer-generated printouts to identify potential intentional program violations by clients or staff.
Reviews case files to determine if files are complete, accurate and meet existing guidelines.
Writes reports of investigative findings.
Interviews service providers, employers, clients and third parties to collect information about the services and assistance provided to obtain evidence of fraud and abuse, to verify information and to inform them of the applicable aspects of the law.
Determines whether or not there was intent by a client to defraud the agency and if the client should be referred for criminal prosecution and/or an administrative hearing.
Represents the agency at Intentional Program Violation (IPV) hearings and criminal court proceedings to present evidence and explain investigation and findings.
Questions witnesses and presents summary of the State’s position at IPV hearings.
Consults with agency employees and witnesses to prepare them for administrative and court appearances.
Makes referrals for recoupment of overpayments when collection activities are warranted, and criminal prosecution is not possible.
Negotiates repayment agreements for overpayments.
Acts as a resource to the public and DHHS staff, receives referrals from the public, DHHS staff, government agencies, other state agencies, law enforcement officials, school officials, etc.