Current jobs related to Senior Medicaid Investigator - Grand Prairie, Texas - Texas Department of Aging & Disability Services
-
Senior Quality Engineer
1 week ago
Grand Prairie, Texas, United States Lockheed Martin Corporation Full timeQuality Engineer Senior Job DescriptionLockheed Martin is seeking a Quality Engineer Senior to support the Precision Fires QA Development Group in Grand Prairie, TX. This position involves working with an integrated team to identify, trend, and resolve non-conformances.Key Responsibilities:Collaborate with Engineering, Manufacturing, and Program Management...
-
Senior Security Representative
1 month ago
Grand Prairie, Texas, United States Lockheed Martin Corporation Full timeJob Title: Senior Security RepresentativeWe are seeking a highly skilled Senior Security Representative to join our team at Lockheed Martin Corporation. As a key member of our security team, you will be responsible for ensuring the confidentiality, integrity, and availability of sensitive information.Job Summary:The Senior Security Representative will...
-
Senior System Safety Engineer
2 weeks ago
Grand Prairie, Texas, United States Butler America Full timeJob Title: Senior System Safety EngineerButler America Aerospace, LLC is seeking a highly skilled Senior System Safety Engineer to join our team.Job Summary:The Senior System Safety Engineer will be responsible for ensuring the safety of our products and systems, ensuring compliance with regulatory requirements and industry standards.Key...
-
Senior Quality Engineer
1 week ago
Grand Prairie, Texas, United States Lockheed Martin Full timeJob DescriptionLockheed Martin is seeking a Quality Engineer Senior to join our team in Grand Prairie, TX. As a member of our Precision Fires QA Development Group, you will play a critical role in ensuring the quality of our products and services.Key Responsibilities:Collaborate with Engineering, Manufacturing, and Subcontracting teams to ensure quality...
-
Senior Systems Engineer
1 week ago
Grand Prairie, Texas, United States Chipton Ross Inc. Full timeJob SummaryWe are seeking a highly skilled Senior Systems Engineer to join our team. The ideal candidate will have a strong background in system architecture analysis and documentation, as well as experience with tools like Cameo and DOORS.Key Responsibilities:Analyze and document system requirements in DOORSAssist with system architecture analysis using...
-
Senior Systems Engineer
2 weeks ago
Grand Prairie, Texas, United States Chipton Ross Inc. Full timeJob SummaryWe are seeking a highly skilled Senior Systems Engineer to join our team at Chipton Ross Inc. in a full-time capacity. The ideal candidate will have a strong background in system architecture analysis, system design, and verification artifacts.Key Responsibilities:Analyze and document system requirements in DOORSAssist with system architecture...
-
Senior Operations Supervisor
7 days ago
Grand Prairie, Texas, United States Penske Full timeJob Summary:As a Senior Operations Supervisor at Penske Logistics, you will be responsible for providing operational leadership to individual contributors and hourly workforce to ensure the execution of daily tasks and activities. This includes supervising logistics operations, including customer service, freight loading and unloading, dispatch, and proper...
-
Senior System Safety Engineer
2 weeks ago
Grand Prairie, Texas, United States Butler America Full timeJob Summary: Butler America Aerospace, LLC. is seeking a highly skilled Senior System Safety Engineer to join our team. As a key member of our safety engineering team, you will be responsible for ensuring the safety of our products and systems. Key Responsibilities: Develop and implement system safety programs in accordance with MIL-STD-882 Conduct hazard...
-
Senior Contracts Management Specialist
3 days ago
Grand Prairie, Texas, United States Lockheed Martin Corporation Full timeJob Summary:We are seeking a highly skilled Senior Contracts Management Specialist to join our team at Lockheed Martin Corporation. In this role, you will be responsible for providing contract administration and negotiation support in all aspects of the contract life cycle, including proposals, negotiations, administration, and contract closeout.Key...
-
Senior Radar Systems Engineer
3 days ago
Grand Prairie, Texas, United States Lockheed Martin Corporation Full timeJob Summary:We are seeking a highly skilled Radar Signal Processing Engineer to join our team at Lockheed Martin Corporation. As a key member of our team, you will be responsible for designing, developing, and implementing advanced radar systems.Key Responsibilities: Develop and optimize signal processing algorithms to enhance radar performance Create and...
-
Security Representative
2 weeks ago
Grand Prairie, Texas, United States Lockheed Martin Corporation Full timeJob DescriptionLockheed Martin's Missiles and Fire Control (MFC) business is seeking an experienced Security Representative to join our security team.Key ResponsibilitiesPerform as the Contractor Program Security Officer (CPSO) for multiple complex and growing programs.Implement and maintain personnel, physical, and technical security measures.Manage...
-
Financial Director for Albers Industrials
3 weeks ago
Grand Prairie, Texas, United States The Albers Group LLC Full timeDirector of Finance Job DescriptionThe Director of Finance is a critical member of the Albers Aerospace management team, responsible for overseeing the financial affairs of the Albers Aerospace Industrials Vertical. This position requires a strong understanding of financial management, accounting principles, and regulatory compliance.Key...
-
Contract Management Specialist
3 weeks ago
Grand Prairie, Texas, United States Lockheed Martin Corporation Full timeJob DescriptionLockheed Martin Missiles and Fire Control is seeking a Senior Contracts Management position in Grand Prairie, TX to support a diverse portfolio of Munitions opportunities in the Precision Fires line of business (GMLRS/ER-GMLRS programs).Key ResponsibilitiesNegotiates, administers, extends, terminates, and renegotiates standard and nonstandard...
-
Service Manager
3 days ago
Grand Prairie, Texas, United States PACCAR Full timeJob SummaryWe are seeking an experienced Service Manager to oversee the day-to-day operations of our Company Store maintenance facility, managing a fleet of 350+ trucks. The ideal candidate will have a strong background in maintenance operations, supervisory experience, and excellent customer service skills.Key ResponsibilitiesDevelop and implement a...
-
Prairie Lea, Texas, United States Optum Full timeJob Title: Registered Nurse RN Utilization Management Quality Auditor San Antonio TexasWellMed, part of the Optum family of businesses, is seeking a Registered Nurse to join our team in San Antonio, TX. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.At Optum, you'll have the...
-
Senior System Safety Engineer
3 weeks ago
Grand Prairie, United States Butler Aerospace & Defense Full timeSenior System Safety Engineer (SSE)Location: Grand Prairie, TXJob ID: #69960Pay Range: $55-6912 Month ContractInterim Secret clearance required to start work on program.The Senior System Safety Engineer (SSE) is responsible for ensuring that the products developed and sold to the customer are safe for the warfighter to use.A successful candidate will employ...
-
Senior System Safety Engineer
3 weeks ago
Grand Prairie, United States Butler Aerospace and Defense Full timeSenior System Safety Engineer (SSE) Location: Grand Prairie, TX Job ID: #69960 Pay Range: $55-69 12 Month ContractInterim Secret clearance required to start work on program.The Senior System Safety Engineer (SSE) is responsible for ensuring that the products developed and sold to the customer are safe for the warfighter to use. A successful candidate will...
-
Senior Operations Analyst
2 days ago
Pleasant Prairie, Wisconsin, United States Uline Full timeSenior Operations AnalystUline is seeking a skilled Senior Operations Analyst to join our team. As a Senior Operations Analyst, you will be responsible for reviewing, auditing, and summarizing operational data to provide executive summaries with recommendations to Uline's President. You will investigate root causes and work with cross-functional areas to...
-
Senior Counsel
3 weeks ago
Sun Prairie, Wisconsin, United States QBE Insurance Group Limited Full timeAbout the RoleWe are seeking a highly skilled and experienced Senior Counsel to join our Corporate and Shared Services Legal Team at QBE Insurance Group Limited. As a Senior Counsel, you will play a pivotal role in providing expert legal guidance across the organization, advising on complex issues, and developing strategic practices to ensure the company's...
-
Senior Accountant
2 weeks ago
Eden Prairie, Minnesota, United States Shared Success Center Full timeJob Title: Senior AccountantAt Shared Success Center, we are seeking a highly skilled Senior Accountant to join our team. As a key member of our accounting department, you will be responsible for providing specialized accounting support to achieve department and corporate goals and objectives.Key Responsibilities:Financial Reporting and Analysis: Prepare...
-
Senior Financial Analyst
2 weeks ago
Eden Prairie, Minnesota, United States AIIStar Full timeJob Title: Senior AccountantJob Summary:This is a senior-level accounting position that will play a key role in maintaining the daily operations of the accounting staff and ensuring data integrity and accuracy.Responsibilities:General Ledger:Maintain chart of accounts, manage month-end closing control log, prepare and post journal entries, perform account...
-
Senior PIP Claims Adjuster
3 weeks ago
Grand Rapids, Michigan, United States The Hanover Insurance Group Full timeJob Title: Senior PIP AdjusterThe Hanover Insurance Group is seeking a highly skilled Senior PIP Adjuster to join our Claims team. As a Senior PIP Adjuster, you will be responsible for investigating, negotiating, and resolving claims in accordance with policy provisions, best practices, and jurisdictional requirements.Key Responsibilities:Investigate and...
-
Senior Antitrust Counsel
2 weeks ago
Eden Prairie, Minnesota, United States UnitedHealth Group Full timeTransforming Healthcare through Antitrust ExpertiseUnitedHealth Group is a leading health care and well-being company dedicated to improving health outcomes worldwide. As a Senior Antitrust Counsel, you will play a critical role in shaping the company's antitrust strategy and ensuring compliance with national and international laws and regulations.Key...
-
Senior Healthcare Researcher
1 week ago
Eden Prairie, Minnesota, United States UnitedHealth Group Full timeUnlock the Power of Healthcare DataAs a Senior Healthcare Researcher at UnitedHealth Group, you will play a critical role in driving business decisions with data-driven insights. You will work closely with our team of experts to develop and apply statistical methods to evaluate clinical program effectiveness, identify and deploy appropriate analytic...
-
Senior Accountant
7 days ago
Eden Prairie, Minnesota, United States Shared Success Center Full timeJob SummaryWe are seeking a highly skilled Senior Accountant to join our team at Shared Success Center. As a key member of our accounting department, you will be responsible for providing specialized accounting support to achieve department and corporate goals and objectives.Key ResponsibilitiesFinancial Reporting and AnalysisPrepare financial and managerial...
-
Systems Safety Engineer
4 weeks ago
Grand Prairie, United States Nesco Resource Full timeJob Description: The Senior System Safety Engineer (SSE) is responsible for ensuring that the products developed at LMMFC and sold to the customer are safe for the warfighter to use. A successful candidate will employ System Safety Engineering techniques which will be performed on the end item and its subsystems. The primary job responsibility will be...
-
Senior Engineering Project Manager
1 week ago
Eden Prairie, Minnesota, United States IKON SOLUTIONS ASIA Full timeAs a Senior Engineering Project Manager at IKON SOLUTIONS ASIA, you will oversee the planning, design, and execution of civil engineering projects, ensuring compliance with design standards and project specifications.Key responsibilities include:Conducting site investigations, surveys, and assessments to gather relevant data for project planning and...
-
Senior Civil Infrastructure Specialist
3 days ago
Eden Prairie, Minnesota, United States IKON SOLUTIONS ASIA Full timeAs a Senior Civil Infrastructure Specialist at IKON SOLUTIONS ASIA, you will be responsible for planning, designing, and overseeing the construction and maintenance of civil engineering projects.Key responsibilities include conducting site investigations, surveys, and assessments to gather relevant data for project planning and feasibility studies.You will...
-
Senior Accounting Professional
6 days ago
Eden Prairie, Minnesota, United States AIIStar Full timeJob Summary:The Senior Accountant will play a key role in maintaining the daily operations of the accounting staff and ensuring data integrity and accuracy. This position will report to the Accounting Manager and will be responsible for a variety of tasks, including general ledger maintenance, month-end closing control log management, journal entry...
-
Senior Software Engineer
4 days ago
Eden Prairie, Minnesota, United States KLDiscovery Full timeJob Title: Senior Software EngineerWe are seeking a highly skilled Senior Software Engineer to join our team at KLDiscovery. As a Senior Software Engineer, you will be responsible for developing and maintaining software applications in support of our family of products and services.Key Responsibilities:Develop and maintain software applications in support of...
-
Senior Quality Assurance Engineer
4 weeks ago
Eden Prairie, Minnesota, United States Nuwellis, Inc. Full timeJob Title: Senior Quality EngineerNuwellis, Inc. is a medical device company dedicated to transforming the lives of patients suffering from fluid overload with its Aquadex SmartFlow ultrafiltration therapy.This senior-level Quality Engineer position is responsible for ensuring the quality and safety of our medical devices, from design to delivery. The...
-
Actuarial Director
2 weeks ago
Eden Prairie, Minnesota, United States UnitedHealth Group Full timeUnlock Your Potential as a Senior Actuarial ConsultantAt UnitedHealth Group, we're committed to helping people live healthier lives and making the health system work better for everyone. As a Senior Actuarial Consultant, you'll play a critical role in driving growth and quality delivery of existing client relationships.Key Responsibilities:Provide strategic...
-
Staff System Safety Engineer
3 weeks ago
Grand Prairie, United States Butler Aerospace & Defense Full timeSenior System Safety Engineer (SSE)Location: Grand Prairie, TXJob ID: #69960Pay Range: $55-6912 Month ContractInterim Secret clearance required to start work on program.The Senior System Safety Engineer (SSE) is responsible for ensuring that the products developed and sold to the customer are safe for the warfighter to use.A successful candidate will employ...
-
Senior Operations Supervisor
4 weeks ago
GRAND PRAIRIE, United States Penske Truck Leasing Full timePosition Summary: Provide operational leadership to individual contributors and hourly workforce to ensure the execution of daily tasks and activities including driver deliveries, loading/unloading of trailers, cross docking and customer service operations in a manner consistent with company services and cost objectives. Supervises most processes...
-
Senior Operations Supervisor
4 weeks ago
GRAND PRAIRIE, United States Penske Truck Leasing Full timePosition Summary: Provide operational leadership to individual contributors and hourly workforce to ensure the execution of daily tasks and activities including driver deliveries, loading/unloading of trailers, cross docking and customer service operations in a manner consistent with company services and cost objectives. Supervises most processes...
Senior Medicaid Investigator
2 months ago
This role is situated within the Provider Field Investigations (PFI) unit of the Medicaid Program Integrity division, reporting directly to a PFI Manager.
The position entails conducting thorough administrative investigations of Medicaid providers concerning allegations of fraud, waste, and/or abuse in the delivery of health and human services across the state.
This role enforces state regulations pertaining to these services and demands strong interviewing capabilities, comprehensive research and data analysis skills, as well as the ability to create detailed investigative reports. The position may require up to 25% travel statewide, including occasional overnight trips.The investigator operates under limited supervision from the PFI Manager, exercising considerable initiative and independent judgment.
As of the current posting, PFI investigators are operating under a mobile work status, which may revert to traditional on-site or telework arrangements based on agency requirements and employee performance.
Key Responsibilities:
Conducts in-depth research, reviews, and investigations of complex complaints and cases alleging Medicaid provider fraud, waste, and/or abuse, providing recommendations for appropriate actions.
Interprets and applies relevant agency, state, and federal policies, procedures, rules, and regulations.Executes timely investigative tasks in alignment with PFI policies and procedures, including adherence to case-specific deadlines set by management.
Secures approval from the Deputy Inspector General for MPI or designee to complete a minimum of four comprehensive investigations annually.
Analyzes and interprets business, financial, and medical documentation. (35%)Summarizes and communicates investigative findings through various oral and written formats. Prepares detailed, comprehensive, and grammatically correct case summaries for each assigned investigation.
Completes timely administrative tasks associated with investigations in accordance with PFI policies and procedures, including investigative timelines.
(10%)Conducts interviews with recipients, witnesses, providers, complainants, and provider staff regarding investigations. (10%)
Develops comprehensive exhibits, including schedules of incorrect claims, to ensure effective presentations in administrative hearings and court cases, as necessary.
Provides testimony and presents evidence in informal reviews and judicial proceedings when required. (10%)Effectively communicates findings to the PFI Manager, Deputy Inspector General for MPI, other staff, and external entities.
Delivers testimony and presents evidence in formal hearings and court proceedings; develops and presents criminal fraud cases to prosecutors when appropriate.
(15%)Engages in consultative visits and establishes relationships with the Attorney General's Medicaid Fraud Control Unit, other state and federal agencies, licensure boards, and external entities to discuss and coordinate Medicaid provider fraud and abuse investigations; interprets program policies, standards, and procedures; conducts training workshops; participates in joint investigations and provides advice and recommendations.
(5%)Develops, recommends, and implements solutions to identified issues.
Reviews, develops, and suggests guidelines, procedures, policies, rules, and regulations aimed at detecting and preventing Medicaid fraud, waste, and program abuse.
Proactively initiates cases or projects designed to generate investigations into fraud, waste, and abuse not reported through the referral or MPI Intake process.
(5%)Assists in developing and conducting training programs. Mentors and supports colleagues and staff from other divisions and agencies as needed. Aids in creating and preparing training and operational manuals, educational materials, and information as necessary. (5%)
Performs additional duties as assigned or required to ensure the smooth operation of the division. Keeps the manager informed as necessary. (5%).
Required Knowledge, Skills, and Abilities:
Familiarity with investigative principles, techniques, and procedures; knowledge of the laws governing agency-regulated activities; and understanding of court procedures, practices, and rules of evidence.
Knowledge of Medicaid program policies and procedures, along with an understanding of fraud and abuse regulations.
Ability to comprehend, interpret, and appropriately apply policies, procedures, rules, and regulations.
Capability to plan, organize, and conduct investigations, surveys, inspections, and examinations; to conduct interviews and gather facts; to evaluate findings and prepare complex, concise legal reports; and to testify in hearings and court proceedings.
Ability to communicate effectively in both oral and written forms.
Ability to establish and maintain effective working relationships with supervisory personnel, colleagues, providers, attorneys, and individuals from other state and federal agencies and boards.
Proficiency in using personal computers and related software, including intermediate competency with MS Word and Excel.
Ability to prioritize tasks, work under time constraints, and operate with minimal supervision.
Ability to work in a virtual environment utilizing tools such as MS Teams, Zoom, WebEx, and similar platforms.
Ability to travel up to 25% of the time, including statewide and/or overnight travel.
Experience with Medicaid Fraud Abuse and Detection System [MFADS], Business Objects, and PI Case Tracker is preferred.
