Fraud Investigator

Eau Claire County • Eau Claire, WI

5d • Remote

About The Position

The Fraud Investigator examines public assistance fraud, conducts fraud prevention activities, and performs benefit recovery activities for overpayment claims for the multi-county Great Rivers Consortium (GRC). This position documents and reports activities in compliance with laws and regulations.

Requirements

• Associate degree in criminal justice, human services, or a related field; or an equivalent combination of education, training, and relevant investigative experience.
• Two (2) years of experience conducting investigations, including investigative interviewing, gathering and evaluating evidence or information, and preparing investigative reports.
• Experience may include criminal, civil, administrative, fraud, compliance, public assistance, or other related investigations.
• Proficiency using computers and electronic systems for documentation, research, communication, and report preparation.
• Must maintain a valid driver’s license and automobile liability insurance meeting or exceeding Wisconsin’s minimum coverage requirements, with proof of insurance provided upon hire and maintained throughout employment.
• Must be a Wisconsin resident.

Nice To Haves

• Experience working with Client Assistance for Reemployment and Economic Support (CARES), Forward Health, State of Wisconsin Kids Information Data System (KIDS), Child Care Statewide Administration on the Web (CSAW), Benefit Recovery Investigation Tracking System (BRITS) and/or ebt EDGE.
• Experience interpreting and applying public assistance policies and procedures related to Medicaid, FoodShare, and Child Care benefits.

Responsibilities

• Examines public assistance fraud.
• Conducts fraud prevention activities.
• Performs benefit recovery activities for overpayment claims.
• Documents and reports activities in compliance with laws and regulations.
• Acts as investigator to the Great Rivers Income Maintenance Consortium.
• Transfers expertise in investigative techniques and methods to provide direction for the course of field investigations.
• Maintains electronic and written files on the progress and status of field investigations in adherence to legal requirements.
• Provides fraud prevention training for consortium staff.
• Monitors achievement of outcome-based performance measures to maintain quality of service.
• Receives, records, and assesses the legitimacy of complaints and referrals of suspected fraud for economic support programs.
• Conducts intensive investigative interviews to determine whether or not fraud was intentionally committed.
• Obtains and verifies third-party information.
• Collaborates with various agencies and support services.
• Maintains strict confidentiality on all contacts made and information gathered.
• Prepares and maintains detailed and concise records and reports in compliance with legal record keeping and reporting requirements.
• Compiles information and prepares written reports on information gathered for the District Attorney's office.
• Records and documents all Front-End Verification (FEV) and fraud investigation referrals and actions taken.
• Determines, conducts, documents, and reports appropriate verification actions.
• Provides effective and credible testimony in court or administrative hearings regarding clients’ allegedly fraudulent activities, investigations, and findings.
• Conducts special case audits on targeted areas, particularly error prone cases.
• Exercises judgement to determine outcome and provide recommendations based on results.
• Establishes and maintains professional working relationships with local and state agencies, law enforcement, employers, and the general public.
• Performs other related duties as required or assigned.

Benefits

• Appointment will be conditional upon successful completion of criminal and caregiver background checks.
• An ergonomically correct and confidential workspace, at own expense, is required for this position when working remotely.
• Employees must provide high speed internet access at own expense when working remotely.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree