SENIOR INVESTIGATOR

City of New York•New York, NY

1d•$59,359 - $68,263

About The Position

The Department of Social Services (DSS), comprising the New York City Human Resources Administration (HRA) and Department of Homeless Services (DHS), provides essential benefits and works to prevent and address homelessness. The DSS Accountability Office protects the integrity of DSS social services programs and ensures compliance with statutory, regulatory, and contractual standards. The Medicaid Provider Investigation Division (MPID) audits and investigates Medicaid providers and recipients suspected of participating in or facilitating provider fraud. Its Criminal Investigations Unit works with law enforcement partners to identify fraud schemes and build cases against recipients and providers engaged in criminal fraud. MPID is recruiting three Fraud Investigator II employees to function as Senior Investigators. Applicants must be permanent in the Fraud Investigator civil service title or permanent in a comparable title eligible for a 6.1.9 title change. The stated hours are 9:00 a.m. to 5:00 p.m.

Requirements

Applicants must be permanent in the Fraud Investigator civil service title or permanent in a comparable title eligible for a 6.1.9 title change.
Qualification may be met with a four-year high school diploma or equivalent and three years of satisfactory, full-time qualifying experience acquired within the United States. Qualifying experience includes investigations involving criminal or fraudulent activity; evaluating credit histories; searching for assets; or researching, compiling, or locating evidence or information to build a case or uncover criminal, corrupt, unlawful, or unethical activity involving public or private funds.
Alternatively, an associate degree or 60 semester credits, including or supplemented by 12 semester credits in specified criminal justice, forensic, police science, criminology, law, or related fields, plus one year of satisfactory, full-time experience as an investigator described above.
Alternatively, a baccalaureate degree from an accredited college or university.
Education and/or experience equivalent to the listed pathways may qualify. Undergraduate credits may substitute for experience at 10 semester credits for three months of full-time experience; all candidates must have at least a four-year high school diploma or equivalent.
Clerical experience in an organization that investigates criminal or fraudulent activities is not acceptable.

Responsibilities

Generate, obtain, and review data from the Medicaid Data Warehouse and other resources to identify patterns of suspected fraud.
Research Medicaid program requirements and regulations governing provider conduct to support data review and identify and demonstrate fraudulent conduct.
Investigate Medicaid providers, persons of interest, and client targets suspected of Medicaid provider fraud.
Obtain relevant documents and identify entity and individual connections; determine owners and affiliates, related entities, Medicaid enrollment and sanction status, New York State licensure, criminal history, and other relevant facts.
Identify clients potentially involved in Medicaid provider fraud schemes by reviewing claims data, intelligence, and other available sources.
Interview clients to obtain or verify information and prepare written interview reports documenting evidence.
Maintain accurate and timely case notes in the case management system, recording investigative steps, pertinent information, and case progression.
Write reports as requested and complete closing memoranda and referral packages summarizing allegations, actions taken, findings, and evidence.
Conduct collateral visits, surveillance, and other field activities as needed to investigate cases and obtain evidence in accordance with approved investigative plans.
Participate in operations with law enforcement partners as required.
Perform other related duties as assigned.