Senior Medicaid Investigator - Provider Integrity

Health & Human Services Comm; 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

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.