Senior Investigator

City of New York • Queens, NY

4d

About The Position

The Department of Social Services (DSS), through its Medicaid Provider Investigation Division (MPID), investigates Medicaid providers and recipients suspected of participating in or facilitating provider fraud. The Criminal Investigations Unit works with law enforcement partners to identify fraud schemes and build cases involving Medicaid recipients and providers. The Senior Investigator will investigate suspected fraud, identify and document evidence, and prepare reports and referral materials. 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 position's hours are 9:00 AM to 5:00 PM.

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.
• Meet one of the stated qualification pathways: a high school diploma or equivalent and three years of qualifying full-time experience; an associate degree or 60 college credits including or supplemented by 12 specified or related credits and one year of qualifying full-time investigator experience; a bachelor's degree; or equivalent education and/or experience.
• 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.
• At least a four-year high school diploma or equivalent is required.
• Clerical experience in an organization that investigates criminal or fraudulent activities is not acceptable.
• Undergraduate college credits may substitute for experience at a rate of 10 semester credits for three months of full-time experience.

Responsibilities

• Generate, obtain, and review Medicaid Data Warehouse and other available data to identify suspected fraud patterns; research Medicaid program requirements and provider regulations to assess data and identify fraudulent conduct.
• Investigate Medicaid providers, persons of interest, and client targets suspected of Medicaid provider fraud; obtain relevant documents and identify connections among entities and individuals, ownership and affiliates, related entities, Medicaid enrollment or 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 sources; interview clients and write reports documenting interview evidence.
• Maintain accurate, timely case notes documenting investigative steps, pertinent information, and case progression; write requested reports and prepare closing memos and referral packages summarizing allegations, actions, findings, and evidence.
• Conduct collateral visits, surveillance, and other field activities as needed under approved investigative plans; participate in operations with law enforcement partners as required.
• Perform other related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED