Senior Medicaid Fraud Investigator

Texas A&M International; San Antonio (TX); On-site; USD 54,000 - 87,000; Full time

Benefits offered by this job

Health insurance (benefits)

Pension plan

Generous time off

Career advancement

Job summary

The Investigator V at the Texas Health and Human Services Commission is responsible for conducting advanced investigations into Medicaid fraud, waste, and abuse. You will coordinate with MCOs, DMOs, and agencies, manage case files, and testify when required.

The role requires extensive investigative experience, knowledge of Medicaid policies, and strong analytical and legal skills. Travel up to 25% may be required; telework is not eligible.

Qualifications

• Graduation from a four-year college or university.
• Four years of specialized experience may be substituted for education on a year-for-year basis.
• Total six years of education and experience combined acceptable.

Responsibilities

• Conducts investigations of Medicaid provider and non-provider fraud, waste, or abuse.
• Manages investigative phases, workflows, and evidence; ensures defensible records.
• Requests and reviews records; drafts subpoenas and maintains chain of custody.

Skills

Investigation expertise

Medicaid program knowledge

Legal procedures familiarity

Communication skills

Data analysis

Education

Bachelor’s degree

Tools

MS Teams

Zoom

WebEx

Microsoft Excel

Microsoft Word

Job description

The Investigator V at the Texas Health and Human Services Commission is responsible for conducting advanced investigations into Medicaid fraud, waste, and abuse. You will coordinate with MCOs, DMOs, and agencies, manage case files, and testify when required.

The role requires extensive investigative experience, knowledge of Medicaid policies, and strong analytical and legal skills. Travel up to 25% may be required; telework is not eligible.