Investigator V

Texas Health and Human Services Commission; San Antonio (TX); On-site; USD 54,000 - 87,000; Full time

Job summary

The Investigator V role at Health & Human Services Commission leads complex Medicaid investigations, guiding all phases from data review to evidence presentation. You will collaborate with state agencies, MCOs, and licensing boards to ensure integrity and accountability in program operations.

Applicants should demonstrate advanced investigative skills, strong analytical abilities, and the capacity to testify when required.

Qualifications

• Advanced knowledge of investigative principles, rules, and evidence.
• Experience with Medicaid or healthcare compliance monitoring is preferred.
• Ability to interpret policies and conduct complex investigations.

Responsibilities

• Lead and manage complex Medicaid investigations from start to finish.
• Coordinate with MCOs/DMOs and agencies; prepare evidence for hearings.
• Prepare reports with findings and recommended actions.
• Testify in administrative or court proceedings where required.
• Travel up to 25% statewide or overnight as needed.

Skills

Investigations

Data analysis

Interviewing

Policy awareness

Education

Bachelor's degree

Tools

Microsoft Excel

Microsoft Word

Case management system

Job description

Posting ID22770-Posted10/30/2026-Health & Human Services Comm-Medicaid Provider Integrity 50-Business and Financial Operations-Not Eligible for Telework- Other Locations (5) -b. $3000 - $4999 per month

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Functional Title: Investigator V Job Title: Investigator V Agency: Health & Human Services Comm Department: Medicaid Provider Integrity 50 Posting Number: 22770 Closing Date: 11/13/2026 Posting Audience: Internal and External Occupational Category: Business and Financial Operations Salary Range: $4,801.16-$7,761.50 Pay Frequency: Monthly Salary Group: TEXAS-B-22 Shift: Day Additional Shift: None Telework: Not Eligible for Telework Travel: Up to 25% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA Exempt/Non-Exempt: Nonexempt Facility Location: Job Location City: SAN ANTONIO Job Location Address: 11307 ROSZELL Other Locations: San Antonio; Austin; Edinburg; Grand Prairie; Houston MOS Codes: 5805,5813,5819,5821,5822,7596,8012,14N,14NX,183X,1D7X1,1N0X1,1S0X1,250X,311A,31A,31B,31D,31PX,351L 351M,35A,35L,35M,3E7X1,3P0X1,43HX,4B0X1,4E0X1,5I0,649X,683X,71SX,749X,783X,89D,89E,EOD,INV,IS,IV,LN MA,ME,MLES,MSSD,MSSE,MSSR,MST,OAP12,OAP14

Job Description

The Investigator V is managed by the Manager of Provider Field Investigations (PFI) within the Texas Health and Human Services (HHS) Office of Inspector General (OIG).

Performs advanced (senior level) work. Works under minimal supervision with considerable latitude for the use of initiative and independent judgment.

The Investigator V conducts and manages all phases of complex full-scale investigations of alleged Medicaid fraud, waste, and/or abuse involving providers and non-providers. Collaborates with Managed Care Organizations (MCOs) and Dental Maintenance Organizations (DMOs), federal and state agencies, entities, and professional and licensing boards to coordinate investigations. Participates in settlement conferences with providers and attorneys and testifies in court.

Essential Job Functions

(EJF 1) Core Investigative Responsibilities and Fieldwork (55%)

Conducts investigations of alleged Medicaid provider and non-provider fraud, waste, and/or abuse to include managing investigative phases, workflows, tasks, and deliverables. Ensures cases are fact-driven and defensible, contain verifiable evidence, and aligned with program integrity standards. Responds to assignments and confirms receipt. Prioritizes workload and adjusts strategies to maintain progress toward deadlines. Completes background research, data review, and case-specific analysis to identify investigative leads, corroborate evidence, and ensure a complete investigative record. Develops an understanding of the data and sampling process utilized in each investigation including population, exclusions, review periods, and other criteria that affect sampling.

Evaluates claims data, provider records, interviews, and collateral information. Performs investigative fieldwork, including provider, staff, and client interviews and documentation, witness statements, and surveillance. Researches, interprets, and applies laws, rules, statutes, policies, and procedures. Updates and maintains case management system and electronic case file.

(EJF 2) Evidence Requests, Collection, Coordination, and Maintenance (15%)

Requests and collects business, financial, and medical records. Drafts administrative subpoenas aligned with the investigative scope, works with OIG Chief Counsel to ensure they are legally defensible. Submits record requests, addresses extension requests with leadership, conducts evidence reviews, and follows up with providers to ensure responsive documentation is received by deadline. Preserves evidence and evidentiary integrity, by following chain-of-custody standards for all collected documents, media, and physical evidence, including recordings, photographs, memoranda of interviews, statement affidavits, emails, texts, faxes, mail, and other evidence. Updates case management system and electronic case file.

(EJF 3) Reporting and Presentation of Investigative Findings (15%)

Synthesizes findings into reports and memoranda. Presents investigative outcomes verbally, virtually, or in writing, clearly explaining rationale, evidentiary foundations, and actions. Develops comprehensive exhibits, including schedules of incorrect claims, to support effective case presentations in hearings before the State Office of Administrative Hearings (SOAH) and/or the HHSC Appeals Division. Testifies and presents evidence during informal reviews and administrative court proceedings.

(EJF 4) Internal and External Liaison and Collaborative Work (5%)

Conducts meetings and maintains relationships. Participates and collaborates with subject matter experts. Recommends and collaborates on internal processes, policy improvements, job aids, and trainings.

Coordinates activities, shares information, and supports investigations or initiatives in accordance with confidentiality and statutory requirements. Collaborates on policy changes, proposing or recommending new policies, and providing feedback.

(EJF 5) Problem Solving, Critical Thinking, and Investigative Innovation (5%)

Identifies fraud patterns, vulnerabilities, and opportunities for new initiatives. Uses critical thinking to evaluate scenarios, resolve challenges, and propose improvements to processes and practices. Develops and presents investigative strategy for leadership approval.

(EJF 6) Additional Duties (5%)

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs duties as assigned. Performs other duties as necessary to achieve the mission of the OIG. Keeps manager informed as required or as necessary.

Licensure, Certification or Registration

The following licenses or certifications are preferred:

• Licensed Professional Counselor (LPC)
• Registered Dental Hygienist (RDH)

Knowledge, Skills and Abilities

• Advanced knowledge of investigative principles, techniques, and procedures of the laws governing the activities regulated by the agency; and of court procedures, practices, and rules of evidence.
• Advanced knowledge of Medicaid program policies and procedures and knowledge of fraud and/or abuse rules and regulations.
• Ability to understand, interpret, and appropriately apply policies, procedures, rules, and regulations.
• Ability to plan, organize, and conduct investigations.
• Ability to conduct interviews and gather facts.
• Ability to evaluate findings and prepare complex, concise reports.
• Ability to testify in hearings and court proceedings.
• Ability to communicate effectively both verbally and in writing.
• Ability to maintain discretion and confidentiality and exercise sound judgment.
• Ability to establish and maintain effective, professional relationships.
• Ability to use personal computers and related software, including analyzing complex queries with advanced functions and formulas in Microsoft Excel to develop reports, pivot tables, and graphs; and ability to prepare correspondence using Microsoft Word to respond to requests and document investigative findings.
• Ability to prioritize tasks and work; work under time constraints.
• Ability to work in a virtual environment with tools such as MS Teams, Zoom, WebEx, and/or similar platforms.
• Ability to travel up to 25% of the time, to include statewide and/or overnight travel.

Initial Screening Criteria

Specialized experience is defined as experience in one or more of the following areas: investigations, audits, accounting, public policy, healthcare administration, contract monitoring, legal work, Texas Medicaid program experience or healthcare compliance monitoring in Medicaid or Medicare, Managed Care Organizations (MCO), Dental Maintenance Organizations (DMO), or Dental Service Organizations (DSO).

Requirement #1: Graduation from a four-year college or university, which culminated in a bachelor's degree.

OR

Requirement #1: Four years of specialized experience, as defined above, may be substituted for the required education on a year-for-year basis.

(NOTE: Any year of specialized experience counted towards Requirement #1 must be in addition to the two years of specialized experience qualified for Requirement #2, below.)

OR

Requirement #1: Any combination of years of education and specialized experience, as defined above, that total six. (NOTE: Any year of specialized experience counted towards Requirement #1 must be in addition to the two years of specialized experience qualified for Requirement #2, below.)

AND

Requirement #2: Two years of specialized experience in any of the following areas: investigations, audits, accounting, public policy, healthcare administration, contract monitoring, legal work, Texas Medicaid program experience or healthcare compliance monitoring in Medicaid or Medicare, Managed Care Organizations (MCO), Dental Maintenance Organizations (DMO), or Dental Service Organizations (DSO).

Additional Information

The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and/or abuse in the provision of HHS in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must complete a national fingerprint-based criminal background check through the Texas Department of Public Safety (TDPS) and Federal Bureau of Investigations (FBI) to determine if they have criminal history record information that constitutes a bar to employment.

The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.

Active Duty, Military, Reservists, Guardsmen, and Veterans

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited tothose listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work.

Telework Disclaimer

This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.