Medicaid Fraud Control Unit Investigator
3 weeks ago
Revised 7/12/2023
General DescriptionThe Medicaid Fraud Control Unit (MFCU) is seeking a highly skilled and experienced investigator to join our team. As a Sergeant Investigator, you will be responsible for conducting complex criminal investigations of Medicaid provider fraud and nursing home related investigations.
Work involves conducting criminal investigations of violations of various state and federal statutes and prosecution assistance as needed. The MFCU works cases jointly with other law enforcement agencies, including the FBI, U.S. Department of Health and Human Services - Inspector General, and IRS.
The ideal candidate will have a strong background in criminal investigations, law enforcement, and healthcare fraud. You will be responsible for planning, participating in, and conducting undercover investigations, surveillance operations, raids, and searches; identifying, gathering, and examining evidence; executing court orders, warrants, and subpoenas; and reporting investigative findings.
Essential Position Functions- Conducts complex criminal investigations of Medicaid provider fraud, and/or assures that nursing home related investigations are addressed professionally and in a timely manner.
- Plans, participates in, and conducts undercover investigations, surveillance operations, raids, and searches.
- Establishes and maintains liaison with outside agencies, associations, groups, and the like whose assistance and cooperation can enhance the mission of MFCU.
- May train, lead, and/or assist with the work of others.
- Performs related work as assigned.
- Responds to emergency situations by serving on-call twenty-four hours per day/seven days per week.
- Maintains relevant knowledge necessary to perform essential job functions.
- Attends work regularly in compliance with agreed-upon work schedule.
- Ensures security and confidentiality of sensitive and/or protected information.
- Complies with all agency policies and procedures, including those pertaining to ethics and integrity.
The minimum qualifications for this position are:
- Education: Graduation from high school or equivalent.
- Education: Sixty credit hours from an accredited college or university; may substitute an associate's or bachelor's degree from an accredited college or university; or full-time investigations; law enforcement; auditing; accounting; compliance monitoring in Medicaid, Medicare, health care insurance, or closely related experience for the required education on a year-for-year basis.
- Experience: Four years full-time criminal investigative experience as a licensed peace officer or comparable federal law enforcement officer.
- TCOLE certification.
- Knowledge of TCOLE training requirements and healthcare fraud investigation training needs.
- Knowledge of Microsoft Office products (i.e. Word, Excel, PowerPoint, Outlook).
- Knowledge of criminal investigative principles, techniques, and methodologies.
- Knowledge of management and administrative principles, techniques, and methodologies.
- Knowledge of agency goals, objectives, rules, regulations, policies, and procedures.
- Knowledge of state and federal statutes, rules, and regulations pertaining to law enforcement activities.
- Knowledge of criminal and civil court proceedings and rules of evidence.
- Skill in effective oral and written communication.
- Skill in researching and interpreting complex rules and regulations.
- Skill in applying investigative techniques and procedures.
- Skill in handling multiple tasks, prioritizing, and meeting deadlines.
- Skill in exercising sound judgment and effective decision making.
- Ability to develop and implement strategic plans and budgets.
- Ability to use and care for firearms.
- Ability to use intermediate impact weapons and Oleoresin Capsicum spray.
- Ability to use physical tactics.
- Ability to conduct complex criminal investigations of Medicaid provider fraud and nursing home related investigations.
- Ability to interpret and apply applicable provisions of the Texas Penal Code, the Texas Code of Criminal Procedure, and federal statutes pertaining to investigations.
- Ability to interpret and apply department policies and procedures.
- Ability to plan, assign, and supervise the work of others.
- Ability to handle stressful situations.
- Ability to receive and respond positively to constructive feedback.
- Ability to work cooperatively in a professional office environment.
- Ability to provide excellent customer service.
- Ability to work in person at assigned OAG work location, perform all assigned tasks at designated OAG work space within OAG work location, and perform in-person work with coworkers (e.g., collaborating, training, mentoring) for the entirety of every work week (unless on approved leave).
- Ability to arrange for personal transportation for business-related travel, with reimbursement.
- Ability to work more than 40 hours as needed and in compliance with FLSA.
- Ability to lift and relocate 30 lbs.
- Ability to travel (including overnight travel) up to 20%.
- Ability to achieve 64% or better of VO2 max on the 2000-meter row, or meet a minimum score of 64% on the 500-meter row test or 4-minute row test, utilizing a Concept 2 Rower.
The preferred qualifications for this position are:
- Experience conducting white collar/economic crime investigations.
- Experience investigating healthcare provider fraud and working with state and federal prosecutors in criminal matters.
- Accomplished practitioner of the MFCU documentation and report writing system or a like system.
- Knowledge of healthcare fraud statutes (state and federal).
To apply for this position, please submit your application through CAPPS Recruit or Work in Texas. A State of Texas application must be completed to be considered, and paper applications are not accepted. Your application for this position may subject you to a criminal background check pursuant to the Texas Government Code.
The OAG is an equal opportunity employer.
-
Sergeant - Medicaid Fraud Control Unit
3 weeks ago
San Antonio, Texas, United States CAPPS, Inc. Full timeJob Title: Sergeant - Medicaid Fraud Control UnitJoin the Medicaid Fraud Control Unit as a Sergeant and contribute to the protection of Medicaid resources and the integrity of the healthcare system. As a Sergeant, you will be responsible for conducting complex criminal investigations of Medicaid provider fraud and nursing home-related investigations.Key...
-
Senior Investigator
1 week ago
San Antonio, Texas, United States CAPPS, Inc. Full timeAbout the RoleWe are seeking a highly skilled and experienced Senior Investigator to join our Medicaid Fraud Control Unit (MFCU) team. As a key member of the team, you will be responsible for conducting advanced criminal investigations of Medicaid provider fraud and nursing home related investigations.Key ResponsibilitiesConduct complex criminal...
-
Medicaid Fraud Investigator
2 weeks ago
San Antonio, Texas, United States CAPPS, Inc. Full timeJob Title: Medicaid Fraud InvestigatorWe are seeking a highly skilled and experienced Medicaid Fraud Investigator to join our team at CAPPS, Inc. The successful candidate will be responsible for conducting complex criminal investigations of Medicaid provider fraud and nursing home related investigations.Key Responsibilities:Conduct thorough investigations of...
-
Sergeant - Medicaid Fraud Investigation Unit
2 months ago
San Antonio, Texas, United States CAPPS, Inc. Full timePosition Overview As a key member of the Medicaid Fraud Control Unit (MFCU) at CAPPS, Inc., you will engage in sophisticated criminal investigations related to Medicaid provider fraud and nursing home issues. Your role will involve collaborating with various law enforcement agencies to ensure compliance with state and federal regulations. CAPPS, Inc. is...
-
Sergeant - Medicaid Fraud Control Unit
1 week ago
San Antonio, Texas, United States CAPPS, Inc. Full timeJob SummaryWe are seeking a highly skilled and experienced Senior Investigator to join our Medicaid Fraud Control Unit team. As a Senior Investigator, you will be responsible for conducting complex criminal investigations of Medicaid provider fraud and nursing home related investigations.Key ResponsibilitiesConduct thorough and detailed investigations of...
-
Senior Fraud Investigator
4 weeks ago
San Antonio, Texas, United States USAA Full timeAbout the RoleWe are seeking a highly skilled and experienced Senior Fraud Investigator to join our team at USAA. As a key member of our Special Investigations Unit (SIU), you will play a critical role in identifying and mitigating fraud risk within our organization.Key Responsibilities:Conduct thorough investigations into suspected fraud cases, utilizing...
-
Fraud Investigator I-OMBP
4 weeks ago
San Antonio, Texas, United States Navy Federal Credit Union Full timeAbout the RoleWe are seeking a skilled and detail-oriented Fraud Investigator to join our team at Navy Federal Credit Union. As a key member of our organization, you will be responsible for performing and documenting investigations related to possible fraud and suspicious activity monitoring.Key ResponsibilitiesInvestigate various types of transactions,...
-
Senior Fraud Investigator
3 weeks ago
San Antonio, Texas, United States United Services Automobile Association - USAA Full timeProtecting USAA and Our MembersAs a dedicated SIU field investigator, you will play a critical role in safeguarding USAA and our members from potential fraudulent claims. Within defined guidelines and framework, you will investigate complex fraud investigations with significant financial impact to USAA.Key ResponsibilitiesConduct thorough investigations into...
-
Senior Fraud Investigator
1 month ago
San Antonio, Texas, United States United Services Automobile Association - USAA Full timeAbout the RoleAs a dedicated Senior Fraud Investigator, you will play a critical role in safeguarding USAA and its members from potential fraudulent claims. Within defined guidelines and framework, you will investigate complex fraud investigations with significant financial impact to USAA.Key ResponsibilitiesConduct thorough investigations into complex fraud...
-
Director, Special Investigations Unit
3 weeks ago
San Antonio, Texas, United States USAA Full timeAbout USAAUSAA is a leading financial services organization dedicated to serving the needs of U.S. military members and their families. Our mission is to facilitate the financial security of millions of Americans who have served their country.The OpportunityWe are seeking a highly skilled and experienced Director, Special Investigations Unit to join our...
-
Director, Special Investigations Unit
3 weeks ago
San Antonio, Texas, United States USAA Full timeAbout the RoleWe are seeking a highly skilled and experienced professional to lead our Special Investigations Unit (SIU) as a Director. As a key member of our Claims organization, you will be responsible for developing and implementing strategies to prevent and detect fraud in our Property & Casualty Insurance business.Key ResponsibilitiesDevelop and execute...
-
Director, Special Investigations Unit
3 weeks ago
San Antonio, Texas, United States USAA Full timeAbout the RoleWe are seeking a highly skilled and experienced professional to lead our Special Investigations Unit (SIU) as a Director. As a key member of our Claims organization, you will be responsible for developing and implementing strategies to prevent and detect fraud in our Property & Casualty Insurance business.Key ResponsibilitiesDevelop and execute...
-
Investigator
6 days ago
San Antonio, Texas, United States Diverse Lynx Full timeJob Title: Special Investigator Job Summary: We are seeking a highly skilled Special Investigator to join our team at Diverse Lynx LLC. As a Special Investigator, you will be responsible for executing fraud investigation cases, conducting regulatory reporting, and developing strategies to combat life company product fraud. Key Responsibilities: * Execute...
-
Director, Special Investigations Unit
3 weeks ago
San Antonio, Texas, United States USAA Full timeAbout USAAUSAA is a leading financial services provider dedicated to serving the military community. Our mission is to facilitate the financial security of millions of U.S. military members and their families. We're committed to giving back to those who have served, and we're working together to build a great experience and make a real impact for our...
-
SIU Claims Investigator
3 weeks ago
San Antonio, Texas, United States USAA Full timeAbout the RoleWe are seeking a skilled SIU Case Manager to join our team at USAA. As a key member of our team, you will play a critical role in evaluating and concluding claims identified by SIU Investigators as having elements of fraud or an intentional act.As an SIU Case Manager, you will investigate unusual, questionable, or suspicious claims or...
-
Financial Crimes Investigator
4 weeks ago
San Antonio, Texas, United States Credit Human Full timeFraud Specialist Role at Credit HumanWe are seeking a skilled Fraud Specialist to join our Fraud Services Department. This critical role is dedicated to identifying and mitigating account and card fraud, minimizing potential losses and protecting our customers.Key Responsibilities:Investigate and analyze fraud patterns and trendsDevelop and implement...
-
San Antonio, Texas, United States Guidehouse Full timeAbout the RoleGuidehouse is seeking a highly skilled Financial Crimes Compliance Investigations and Quality Control Analyst to join our team. As a key member of our team, you will play a critical role in ensuring the integrity of our financial systems and processes.Key ResponsibilitiesPerform AML alert/case reviews to mitigate risks associated with financial...
-
Fraud Operations Specialist
1 month ago
San Antonio, Texas, United States Citigroup Inc Full timeAbout the RoleThis is an exciting opportunity to join Citigroup Inc as a Fraud Operations Specialist, where you will play a critical role in protecting our clients' accounts and identities from fraudulent activities.Key ResponsibilitiesConduct thorough risk assessments to identify potential fraud and minimize financial impact.Deliver exceptional customer...
-
San Antonio, Texas, United States Guidehouse Full timeJob SummaryGuidehouse is seeking a highly skilled Financial Crimes Compliance Investigations and Quality Control Analyst to join our team. As a key member of our team, you will be responsible for performing AML alert/case reviews, applying research and analytic techniques to mitigate risks associated with financial crimes, and conducting end-to-end reviews...
-
San Antonio, Texas, United States Guidehouse Full timeJob SummaryGuidehouse is seeking a highly skilled Financial Crimes Compliance Investigations and Quality Control Specialist to join our team. As a key member of our team, you will be responsible for performing AML alert/case reviews, applying research and analytic techniques to mitigate risks associated with financial crimes, and conducting end-to-end...
