SENIOR INVESTIGATOR

City of New York; New York (NY); On-site; USD 59,000 - 68,000; Full time

Job summary

The City of New York seeks a Fraud Investigator II to join the Medicaid Provider Investigation Division (MPID) within the Department of Social Services in New York City.

The role includes reviewing data from the Medicaid Data Warehouse, investigating suspected Medicaid provider fraud, interviewing parties, and documenting findings in written reports. Hours are 9 AM - 5 PM, with duties across data, fieldwork and collaboration with law enforcement partners.

Qualifications

• A four-year high school diploma or its educational equivalent and three years of satisfactory, full-time experience in investigations or related areas.
• An associate degree with 12 criminal justice credits and one year of investigative experience.
• Bachelor's degree or equivalent education/experience combination.

Responsibilities

• Generate, obtain and review data from the Medicaid Data Warehouse and other resources to identify patterns of suspected fraud.
• Conduct investigations of Medicaid providers, persons of interest and clients suspected of Medicaid provider fraud.
• Interview clients to obtain or verify information and write reports documenting evidence.
• Maintain accurate case notes in the case management system and prepare closing memos and referrals.

Skills

Criminal investigations

Data review

Interviewing

Education

High school diploma or equivalent

Associate degree + 12 credits in criminal justice or related field

Bachelor's degree

Tools

Case management system

Medicaid Data Warehouse (MDW)

Job description

• Job Category: Administration & Human Resources
• Salary Band: $60,000 to $70,000
• Compensation: USD 59,359 - USD 68,263

Job Description

APPLICANTS MUST BE PERMANENT IN THE FRAUD INVESTIGATOR CIVIL SERVICE TITLE OR BE PERMANENT IN A COMPARABLE TITLE ELIGIBLE FOR 6.1.9 TITLE CHANGE.

The Department of Social Services (DSS) is comprised of the administrative units of the New York City Human Resources Administration (HRA) and the Department of Homeless Services (DHS). HRA is dedicated to fighting poverty and income inequality by providing New Yorkers in need with essential benefits such as Food Assistance and Emergency Rental Assistance. DHS is committed to preventing and addressing homelessness in New York City by employing a variety of innovative strategies to help families and individuals successfully exit shelter and return to self-sufficiency as quickly as possible.

The DSS Accountability Office (DSS-AO) is responsible for protecting the integrity of social services programs administered by the New York City Department of Social Services (DSS) and ensuring that DSS complies with all statutory, regulatory, and contractual standards.

Medicaid Provider Investigation Division (MPID) conducts audits and investigations of Medicaid providers and recipients suspected of participating in or facilitating provider fraud. The Criminal Investigations Unit works collaboratively with several law enforcement partners to identify fraud schemes and to build successful cases against Medicaid recipients and providers engaged in criminal fraud.

MPID is recruiting for (3) three Fraud Investigator II to function as Senior Investigator, who will:

• Generate, obtain and review data from the Medicaid Data Warehouse (MDW) and other available resources to identify patterns of suspected fraud. Research Medicaid program requirements and regulations governing Medicaid provider conduct to facilitate review of data and to identify and demonstrate fraudulent conduct.
• Conduct investigations of Medicaid providers, persons of interest and client targets suspected of engaging in Medicaid provider fraud. Obtain relevant documents and identify entity and individual connection. Determine owner(s)/affiliate(s), related entities, Medicaid enrollment/sanction status, NYS licensure, criminal history, and other relevant facts.
• Identify clients potentially engaged in Medicaid provider fraud schemes by reviewing claims data, intelligence and all other available sources. Interview clients to obtain and/or verify information. Complete written reports of interviews to document evidence.
• Maintain accurate and timely case notes in the case management system. Maintain case notes to record steps taken and to summarize pertinent information obtained. Maintain case notes to document case progression. Write reports as requested. Complete closing memos and referral packages to summarize allegations, action taken, findings and evidence.
• Conduct collateral visits, surveillance, and other field activities as needed to investigation 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.

Hours/Shift: 9AM - 5PM

FRAUD INVESTIGATOR - 31113

Qualifications

1. A four-year high school diploma or its educational equivalent and three years of satisfactory, full-time experience, acquired within the United States in one or a combination of the following:
   • a . performing investigations involving criminal and/or fraudulent activities; or
   • b. evaluating credit histories; or
   • c. searching for assets; and/or
   • d. researching, compiling and/or locating evidence or information in order to build a case or uncover activities of a criminal, corrupt, unlawful or unethical nature involving public or private funds; or
2. An associate degree or 60 semester credits from an accredited college or university, including or supplemented by 12 semester credits from an accredited college or university in criminal justice, forensic auditing, forensic science, police science, criminology, criminal justice administration and planning, and/or law or a related field and one year of satisfactory, full-time experience as an investigator as described in “1” above; or
3. A baccalaureate degree from an accredited college or university; or
4. Education and/or experience equivalent to “1”, “2” or “3” above. Undergraduate college credit can be substituted for experience on the basis of 10 semester credits from an accredited college or university, for three months of full-time experience. However, all candidates must have at least a four-year high school diploma or its educational equivalent.

Clerical experience in an organization which investigates criminal or fraudulent activities is not acceptable.

Additional Information

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.

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