Medicaid Fraud Investigator/Special Agent

State of Colorado•Denver, CO

14d•Hybrid

About The Position

The Colorado Department of Law’s Consumer Protection Section is hiring a Special Agent III for the Colorado Medicaid Fraud, Abuse & Neglect Unit (MFANU). The unit investigates and pursues civil and criminal matters involving Medicaid provider fraud and patient abuse or neglect, working with attorneys, investigators, analysts, and local, state, and federal partners to protect public resources and vulnerable people across Colorado. The Special Agent III independently conducts complex criminal, civil, and administrative investigations. The role evaluates allegations, develops investigative strategies, conducts interviews, analyzes medical, financial, billing, electronic, and other records, and gathers and preserves evidence. The agent prepares investigative and legal-support materials, supports prosecution and civil litigation, and may testify in court. The position also provides investigative guidance and training to colleagues and partner agencies, participates in public outreach, and may be assigned responsibility for MFANU property and evidence management. Candidates must be Colorado P.O.S.T. certified at hire, proficient with a handgun, hold a valid Colorado driver’s license, and be available to travel within and outside Colorado, sometimes on short notice. Work outside regular business hours, including early mornings, evenings, weekends, and overnight assignments, may be required for investigations, search warrants, or trial preparation. The position is not on-call. A hybrid work schedule may be available after an initial training period.

Requirements

Six years of professional investigative experience as a sworn detective or criminal investigator with a government or law enforcement agency, conducting felony-level criminal investigations and serving as lead investigator in felony cases resulting in charges filed in criminal court; alternatively, a combination of directly related education in Criminal Justice, Psychology, Sociology, or a closely related field and qualifying investigative experience totaling six years.
Applicants qualifying through the education-and-experience combination must submit transcripts with the application; unofficial transcripts are acceptable.
Colorado P.O.S.T. certification at the time of hire, including applicable physical and psychological evaluation requirements.
Proficiency with a handgun.
Availability to travel within and outside Colorado, sometimes on short notice.
Availability to work nights and/or weekends when necessary; assignments may include early mornings, evenings, weekends, and overnight work.
Successful completion of a thorough criminal and personal background check, including review of prior-employment personnel files.
Valid Colorado driver’s license.
Strong organizational skills, including multitasking, prioritizing, and meeting deadlines.
Demonstrated experience managing or leading large-scale or complex investigations.
Strong oral and written communication skills, including concise and effective communication.
Customer service and interpersonal skills, including the ability to work on a team.
Strong critical-thinking and analytical skills.
Complete application documenting relevant education, training, and experience; applications marked “See Resume” or left blank will not be considered.
A writing sample must be attached to the application; an affidavit is strongly preferred. Applications without a writing sample will be removed from consideration.

Nice To Haves

Experience investigating or researching violations of state and federal regulations.
Experience with Medicaid or Medicare regulations and statutes.
Experience investigating document-intensive white-collar fraud cases from intake through completion.
Experience working with medical and bank records during investigations.
Experience using database programs such as Excel or Access to analyze data and track evidence.
Proficiency in Spanish, Chinese, German, Vietnamese, or another commonly spoken language in Colorado.
Forensic interviewer training.
Experience planning tactical operations.
Experience working with multidisciplinary investigation and prosecution teams, including state or federal agency partners.
Experience conducting public outreach.
Certified Fraud Examiner credential.
Experience or training as a field training officer or law enforcement instructor.
Participation in health care fraud or elder abuse task forces or committees.
Experience investigating cases involving vulnerable populations, including victims or witnesses with developmental or intellectual disabilities.
Experience managing an active caseload in a fast-paced environment.

Responsibilities

Independently conduct complex criminal, civil, and administrative investigations involving Medicaid provider fraud and patient abuse or neglect.
Evaluate complaints and referrals for jurisdiction, investigative priorities, potential violations, and appropriate actions.
Develop investigative plans, identify leads, and determine the scope, methods, and resources needed for investigations.
Investigate alleged violations of state and federal Medicaid laws and related offenses, including theft, fraud, forgery, cybercrime, and crimes against persons.
Interview suspects, victims, witnesses, regulatory officials, and other individuals.
Obtain, examine, and analyze medical, financial, billing, electronic, and other records to identify fraud patterns and establish relevant facts.
Obtain and execute search warrants; collect and preserve evidence using appropriate investigative techniques and resources.
Coordinate investigative work with attorneys, compliance investigators, forensic accountants, analysts, and law enforcement agencies.
Assess and prioritize assigned investigations based on public safety, statutory deadlines, evidence, and case progression.
Prepare investigative reports, affidavits, search warrants, court orders, records requests, and other legal and investigative documents.
Document investigative activities, interviews, evidence, findings, and exculpatory information accurately and promptly.
Organize, analyze, and present complex information using spreadsheets, databases, charts, graphs, and other visual presentations.
Review investigative reports and supporting materials for accuracy, completeness, and compliance with investigative and evidentiary standards.
Serve as case agent in criminal and civil matters and support prosecution and litigation.
Collaborate with prosecutors and investigative team members to evaluate evidence, identify investigative gaps, and prepare cases for grand jury or trial.
Prepare exhibits, coordinate witness preparation, assist with courtroom presentations, and testify in judicial proceedings.
Manage multiple investigations and litigation-related assignments while meeting deadlines.
Provide investigative guidance and technical assistance to less experienced investigators and law enforcement partners.
Participate in outreach, informational meetings, and educational presentations; develop materials for different audiences.
Build and maintain collaborative relationships with law enforcement and regulatory agencies and identify opportunities for interagency collaboration.
If assigned as Property and Evidence Manager, obtain required training certification; conduct annual inventories; maintain documentation, secure storage, and chain of custody; update procedures; train staff; and coordinate evidence disposition.

Benefits

Comprehensive State of Colorado benefits package, including competitive medical and dental health plans.
Employer-paid life insurance.
Paid vacation and sick leave earned each month.
10 paid holidays per year.
Retirement plans with Colorado PERA, including flexible retirement benefits and 401(k) and 457 plans.
Public Service Loan Forgiveness eligibility for qualifying borrowers and employment.
Free access to an on-site fitness center.
Career advancement opportunities throughout the State personnel system.
Flexible work schedules and other work-life programs.
Professional development opportunities.
Employee discount program.
Training, coaching, and ongoing professional growth opportunities.