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Investigator V
3 months ago
The Office of Inspector General (OIG) Benefits Program Integrity (BPI) Field Investigator V reports to the BPI Unit Manager. BPI Field Investigators conduct highly complex administrative and criminal investigations involving recipients of HHS programmatic services, such as Medicaid; the Children’s Health Insurance Program (CHIP); the Supplemental Nutrition Assistance Program (SNAP); Temporary Assistance for Needy Families (TANF); and the Women, Infants, and Children’s (WIC) program. The BPI Field Investigator V is responsible for investigating referrals of fraud, waste, and abuse by HHS clients, conducting thorough research and evidence gathering activities, and determining whether the information collected represents a violation of program laws, rules, or regulations according to applicable evidentiary standards.
The Field Investigator V coordinates and conducts investigations according to laws, regulations, agency policies, and professional standards. The position reviews and analyzes records and reports from multiple agency, state, and federal databases; collaborates with both internal and external stakeholders to obtain verification and evidence; understands and applies relevant eligibility requirements; and calculates and establishes overpayment claims. The position obtains business records affidavits, submits subpoenas, and coordinates with law enforcement or other state and federal entities. Field Investigators are responsible for conducting investigative activities to collect evidence that satisfies either the “clear and convincing” standard for administrative fraud proceedings or the “beyond a reasonable doubt” standard for criminal fraud proceedings. This may include obtaining subject and witness statements, conducting interrogative interviews, identifying and locating involved parties, and possibly conducting surveillance. Field Investigators present evidence and testify at both HHS administrative hearings and criminal proceedings. Field Investigator V plans travel and coordinates field activities within the multi-county area of Region 7.
The position prepares and presents training; reviews and/or develops investigative techniques; assists with development of policies and procedures for conducting investigations; recommends improvements, changes, or modifications to BPI processes to increase efficiency and effectiveness of division activities and promote program integrity; and performs other related duties as assigned. May assist the Electronic Benefits Trafficking (EBT) division in conducting covert benefits trafficking investigations. Works under limited supervision with considerable latitude for the use of initiative and independent judgment. Essential Job Functions:
35% Researches, collects evidence, reviews records, and examines potential criminally prosecutable allegations through multiple agency, state, and federal systems to determine program compliance and identify fraud. Interacts and exchanges information with various internal and external stakeholders; coordinates with law enforcement organizations and other state and federal agencies; conducts subject, witness, and collateral interviews regarding suspected violators to meet stringent evidentiary standards; completes other evidence-gathering techniques as necessary to substantiate fraud; and coordinates complex investigations.
30% Coordinates, evaluates, summarizes, and documents investigative findings. Prepares records, correspondence, and complex investigative reports. Examines, investigates, and analyzes the client’s activities to ensure compliance with statutory standards and regulations. Reviews and researches the legal aspects of investigations and recommends action as appropriate. Provides information for subpoena drafting and serving. Prepares cases for presentation at hearing or in court. Testifies and presents evidence in formal hearings and court proceedings.
20% Calculates overpayments across multiple programs with differing and intricate requirements that vary depending upon the services and circumstances of a particular case. Establishes intentional program violation overpayment claims. Tracks adjudication and disposition actions, initiates restitution collection, and coordinates disqualifications, as applicable.
10% Maintains clear and thorough investigative documentation and implements well-organized electronic filing and documentation systems. Employs organizational techniques to manage a high volume of investigations at various stages simultaneously, including planning travel and coordinating field activities. Responds to inquiries, callbacks, and correspondence from principles and collaterals involved in an investigation, providing accurate and clear information and employing investigative interviewing techniques to obtain information relevant to the investigation.
5% Coordinates with BPI leadership to recommend and implement process improvements that increase efficiency and effectiveness of investigative activities and documentation. Adheres to confidentiality requirements and records retention schedules. May review samples of completed investigations to ensure the use of consistent and correct application of policy and promote quality. May monitor and report on investigative trends and statistics. May prepare and deliver training, assist with policy and procedure or job aid development and review, and provide input into and assist in testing automated system enhancements or fixes.
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Knowledge Skills Abilities:
•Knowledge of office management and HHS administrative procedures.
•Knowledge of investigative principles, techniques, and procedures.
•Knowledge of administrative hearing and court procedures, practices, and rules of evidence.
•Knowledge of state and federal laws, regulations, and policies related to health and human services.
•Knowledge of HHS social services programs and eligibility requirements.
•Experience in applying HHS social services program eligibility requirements to recipient investigations.
•Experience in using automated systems for documentation, research, and tracking.
•Skill in communicating effectively both orally and in writing.
•Skill in conducting investigative interviews and interrogations, both remotely and in person.
•Skill in conducting legal research and analysis.
•Skill in the use of computer/laptop equipment and applicable software applications.
•Skill in performing sophisticated budget calculations and using mathematical formulas.
•Skill in handling multiple competing priorities and meeting deadlines.
•Skill in using Excel and other Office Suite software applications to analyze data and produce complex reports.
•Ability to establish and maintain effective working relationships with others.
•Ability to organize research and gather evidence.
•Ability to interpret and apply laws and regulations.
•Ability to plan, organize, and conduct multiple complex investigations simultaneously.
•Ability to apply agency policies and guidelines and determine employee or recipient compliance.
•Ability to compile, evaluate findings, and present information relevant to investigations.
•Ability to use facts to prepare high-quality investigative reports for administrative hearings and criminal prosecution with strong attention to detail that clearly demonstrate how the evidence gathered proves that fraud occurred.
•Ability to provide factual and convincing testimony in hearings or court proceedings.
•Ability to develop training materials and instruct and train others.
